Provider Demographics
NPI:1952375784
Name:GOLLEHON, STEVEN G (MD DDS FACS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:G
Last Name:GOLLEHON
Suffix:
Gender:M
Credentials:MD DDS FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 EAST WENDOVER AVE SUITE 111
Mailing Address - Street 2:PIEDMONT ORAL MAXILLOFACIAL FAC CTR
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401
Mailing Address - Country:US
Mailing Address - Phone:336-273-1000
Mailing Address - Fax:
Practice Address - Street 1:301 EAST WENDOVER AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-273-1000
Practice Address - Fax:336-275-5519
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902GJMedicaid
SCZN6514Medicaid
NC128EJOtherBCBS
SCZN6514Medicaid
NC89902GJMedicaid