Provider Demographics
NPI:1801977525
Name:GOLDEN, ROBERT D (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:GOLDEN
Suffix:
Gender:M
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:PO BOX 80549
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-8549
Mailing Address - Country:US
Mailing Address - Phone:770-483-8816
Mailing Address - Fax:770-483-0075
Practice Address - Street 1:990 IRIS DR SW
Practice Address - Street 2:SUITE 202
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6602
Practice Address - Country:US
Practice Address - Phone:770-483-8816
Practice Address - Fax:770-483-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0100271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice