Provider Demographics
NPI:1881715753
Name:GOLAB, JONATHAN J (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:GOLAB
Suffix:
Gender:M
Credentials:DDS, PA
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Mailing Address - Street 1:3020 BROADMOOR LN
Mailing Address - Street 2:STE. 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2703
Mailing Address - Country:US
Mailing Address - Phone:972-691-1700
Mailing Address - Fax:972-691-8269
Practice Address - Street 1:3020 BROADMOOR LN STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2705
Practice Address - Country:US
Practice Address - Phone:469-444-2119
Practice Address - Fax:972-691-8269
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX189161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX260491Medicare UPIN