Provider Demographics
NPI:1720159031
Name:GOULD, JOEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DAVID
Last Name:GOULD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ROSECRANS AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2462
Mailing Address - Country:US
Mailing Address - Phone:310-640-0967
Mailing Address - Fax:310-607-9292
Practice Address - Street 1:1200 ROSECRANS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2462
Practice Address - Country:US
Practice Address - Phone:310-640-0967
Practice Address - Fax:310-607-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice