Provider Demographics
NPI:1669166963
Name:GOCHIASHVILI, TAMARI (DMD)
Entity type:Individual
Prefix:
First Name:TAMARI
Middle Name:
Last Name:GOCHIASHVILI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LOCUST TER
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1404
Mailing Address - Country:US
Mailing Address - Phone:732-900-0731
Mailing Address - Fax:
Practice Address - Street 1:225 GORDONS CORNER RD
Practice Address - Street 2:STE1
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726
Practice Address - Country:US
Practice Address - Phone:973-972-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03026300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist