Provider Demographics
NPI:1144057688
Name:GOLOJUCH, NINA C (DMD)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:C
Last Name:GOLOJUCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 S MATLACK ST APT 415
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7683
Mailing Address - Country:US
Mailing Address - Phone:973-666-0286
Mailing Address - Fax:
Practice Address - Street 1:795 E MARSHALL ST STE 200
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:484-218-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030430001223X0400X
PADS0448711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics