Provider Demographics
NPI:1669777199
Name:GOROSKI DENTAL CORPORATION
Entity type:Organization
Organization Name:GOROSKI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GOROSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-238-9581
Mailing Address - Street 1:1036 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2559
Mailing Address - Country:US
Mailing Address - Phone:805-238-9581
Mailing Address - Fax:805-238-5655
Practice Address - Street 1:1036 VINE ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2559
Practice Address - Country:US
Practice Address - Phone:805-238-9581
Practice Address - Fax:805-238-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty