Individual
DR. MICHAEL KEITH GOULSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., D.M.D.
Contact information
Practice address
295 DURHAM AVE, SUITE 213, SOUTH PLAINFIELD, NJ 07080-2548
(908) 222-0040
(908) 222-0041
Mailing address
295 DURHAM AVE, SUITE 213, SOUTH PLAINFIELD, NJ 07080-2548
(908) 222-0040
(908) 222-0041
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
050810
NY
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
22D102509200
NJ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS037951
PA
Other
Enumeration date
10/17/2008
Last updated
11/18/2014
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