Provider Demographics
NPI:1982054847
Name:GOLUB, ALEXANDER (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GOLUB
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 1:337 N CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4901
Mailing Address - Country:US
Mailing Address - Phone:717-823-7292
Mailing Address - Fax:
Practice Address - Street 1:337 N CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4901
Practice Address - Country:US
Practice Address - Phone:717-823-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist