Provider Demographics
NPI:1649303736
Name:GOH, IRWAN (DDS)
Entity type:Individual
Prefix:DR
First Name:IRWAN
Middle Name:
Last Name:GOH
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 1:2653 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2845
Mailing Address - Country:US
Mailing Address - Phone:702-732-3754
Mailing Address - Fax:702-737-1494
Practice Address - Street 1:2653 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2845
Practice Address - Country:US
Practice Address - Phone:702-732-3754
Practice Address - Fax:702-737-1494
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4721T1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice