Provider Demographics
NPI:1740345511
Name:GOLOB DEEB, JANINA (DDS, MS)
Entity type:Individual
Prefix:
First Name:JANINA
Middle Name:
Last Name:GOLOB DEEB
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 WARBLER WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7124
Mailing Address - Country:US
Mailing Address - Phone:520-481-2802
Mailing Address - Fax:
Practice Address - Street 1:521 N 11TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5045
Practice Address - Country:US
Practice Address - Phone:804-828-5493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD53801223P0300X
VA04014139581223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics