Provider Demographics
NPI:1053351098
Name:GOULD, ALAN JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JAY
Last Name:GOULD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15068 JOG RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-1218
Mailing Address - Country:US
Mailing Address - Phone:561-499-2686
Mailing Address - Fax:
Practice Address - Street 1:15068 JOG RD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1218
Practice Address - Country:US
Practice Address - Phone:561-499-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL127011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice