Individual
KURT GOODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
228 E HOSPITAL RD, FORT GORDON, GA 30905-6011
(706) 787-5531
Mailing address
228 E HOSPITAL RD, FORT GORDON, GA 30905-6011
(706) 787-5531
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
28236
TX
1223E0200X
Endodontics
61690
KS
1223E0200X
Endodontics
Primary
DN122928
GA
1223G0001X
General Practice Dentistry
28236
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10383
DENTAL LICENSE
KY
01
—
28236
DENTAL LISCENSE
TX
01
—
61690
DENTAL LICENSE
KS
01
—
DN122928
DENTAL LICENSE
GA
Enumeration date
08/21/2012
Last updated
11/21/2022
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