Individual
DR. SAMUEL GOODLOE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1321 MILLERSPORT HWY, SUITE #201, WILLIAMSVILLE, NY 14221-2900
(716) 626-0001
(716) 626-0031
Mailing address
1321 MILLERSPORT HWY, SUITE #201, WILLIAMSVILLE, NY 14221-2900
(716) 626-0001
(716) 626-0031
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
044038
NY
208600000X
Surgery Physician
208101
NY
Other
Enumeration date
05/08/2006
Last updated
11/17/2010
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