Provider Demographics
NPI:1295877959
Name:GOULDIN, ASHTON GARRETT (DDS, MS, PC)
Entity type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:GARRETT
Last Name:GOULDIN
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W BROAD ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4235
Mailing Address - Country:US
Mailing Address - Phone:703-534-1766
Mailing Address - Fax:703-534-1979
Practice Address - Street 1:103 W BROAD ST
Practice Address - Street 2:SUITE 601
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4235
Practice Address - Country:US
Practice Address - Phone:703-534-1766
Practice Address - Fax:703-534-1979
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics