Organization
GOODLOE DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIKA GOODLOE D.M.D. (PRESIDENT)
(601) 859-9595
Entity
Organization
Contact information
Practice address
1207 W PEACE ST, CANTON, MS 39046-9037
(601) 859-9595
(601) 859-9395
Mailing address
PO BOX 449, CANTON, MS 39046-0449
(601) 859-9595
(601) 859-9395
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2942-96
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660220
—
MS
Enumeration date
08/15/2011
Last updated
08/15/2011
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