1912031337 NPI number — DR. TIMOTHY COCHRAN GOULD DMD

Table of content: DR. TIMOTHY COCHRAN GOULD DMD (NPI 1912031337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912031337 NPI number — DR. TIMOTHY COCHRAN GOULD DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULD
Provider First Name:
TIMOTHY
Provider Middle Name:
COCHRAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912031337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 RANDOM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORRY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16407-9020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-664-0815
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33533 WEST 12 MILE ROAD SUITE 150
Provider Second Line Business Practice Location Address:
SMILE PROGRAM
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-967-2276
Provider Business Practice Location Address Fax Number:
814-967-3812
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS022321L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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