Individual
DR. CHAD JORDAN GOLLAHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
148 S 1100 E, AMERICAN FORK, UT 84003-2817
(801) 756-6048
Mailing address
79 W ALEXANDRINE ST, DETROIT, MI 48201-2015
(801) 473-9055
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10789138-9923
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2016
Last updated
11/05/2018
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