Provider Demographics
NPI:1811918162
Name:MYRON L. GOTTFRIED, DDS, PLLC
Entity type:Organization
Organization Name:MYRON L. GOTTFRIED, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-254-9692
Mailing Address - Street 1:215 JUSTICE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9575
Mailing Address - Country:US
Mailing Address - Phone:828-665-6666
Mailing Address - Fax:828-665-4743
Practice Address - Street 1:1415 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1721
Practice Address - Country:US
Practice Address - Phone:828-254-9692
Practice Address - Fax:828-259-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93293OtherBCBSNC