NPIMap

Organization Active NPI

Harrison W. Gollob DMD PA

  • Dental Clinic/Center
  • Melbourne, FL
National Provider Identifier
1952077208
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
HARRISON W. GOLLOB DMD PA
Practice address
130 Interlachen Rd Ste a
Melbourne, FL 32940-1994
Phone
(404) 319-0919
NPI assigned
Aug 17, 2021
Last updated
Aug 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Authorized official

Name
Harrison W Gollob, DMDNPI 1891134441
Title
President
Phone
(404) 319-0919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

130 Interlachen Rd Ste a
Melbourne, FL 32940-1994

Mailing address

130 Interlachen Rd Ste a
Melbourne, FL 32940-1994
Phone (404) 319-0919

National Provider Directory

National Provider Directory

Locations

130 Interlachen Rd
Ste A
Melbourne, FL 32940
Phone (321) 255-4644

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1952077208",
    "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": "404-319-0919"
        },
        {
            "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": "404-319-0919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISON W. GOLLOB DMD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-10",
        "status": "A",
        "authorized_official_last_name": "GOLLOB",
        "authorized_official_first_name": "HARRISON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-319-0919",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.