Individual
LAURA ELIZABETH GOODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
2100 MILLER PARK WAY, WEST MILWAUKEE, WI 53219-1641
(262) 436-3363
Mailing address
N97W14947 BURNING BUSH CT, GERMANTOWN, WI 53022-6628
(608) 712-8195
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1001695
WI
1223P0221X
Pediatric Dentistry
30-023846
OH
Other
Enumeration date
06/10/2011
Last updated
03/17/2018
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