Provider Demographics
NPI:1871918391
Name:GOLWAY, EILEEN C (DMD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:C
Last Name:GOLWAY
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 1:6801 NW 9TH BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605
Mailing Address - Country:US
Mailing Address - Phone:352-333-3683
Mailing Address - Fax:352-333-3684
Practice Address - Street 1:6801 NW 9 BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-333-3683
Practice Address - Fax:352-333-3684
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist