Provider Demographics
NPI:1700068475
Name:GOUDA DENTAL CORPORATION
Entity Type:Organization
Organization Name:GOUDA DENTAL CORPORATION
Other - Org Name:GALAXY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-782-9297
Mailing Address - Street 1:827 W HENDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-1742
Mailing Address - Country:US
Mailing Address - Phone:559-782-9255
Mailing Address - Fax:
Practice Address - Street 1:827 W HENDERSON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1742
Practice Address - Country:US
Practice Address - Phone:559-782-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty