Harrison William Gollob, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN20164 Issued in FL

Practice address

130 Interlachen Rd Ste a
Melbourne, FL 32940-1994

Phone

(321) 255-4644

NPI assigned

Jun 17, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Harrison W. Gollob DMD PA

  • Dental Clinic/Center
  • Melbourne, FL
  • NPI 1952077208
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1891134441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 INTERLACHEN RD STE A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329401994",
            "telephone_number": "321-255-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 INTERLACHEN RD STE A",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329401994",
            "telephone_number": "321-255-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLOB",
        "first_name": "HARRISON",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-17",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN20164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amelia Gold, LCSW
• Scott L Gold, MD
• Sarah Goldberg, PA
• Nanialei Golden, MD
• James Golian
• Ayleen Gomez Lopez, MA, LPC, LMHC
• Amanda Gomez Marquie, DC
• Roberto A Gomez-Suarez, M.D.
• Melany Gomez
• Bo Gong

• General Practice Dentistry in Melbourne, FL
• Providers in Melbourne, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.