Provider Demographics
NPI:1366611915
Name:GOLNICK PEDIATRIC & ADOLESCENT DENTISTRY
Entity type:Organization
Organization Name:GOLNICK PEDIATRIC & ADOLESCENT DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:248-668-0022
Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 1180
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-668-0022
Mailing Address - Fax:248-668-2162
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1180
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-668-0022
Practice Address - Fax:248-668-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009055261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental