Individual
DR. GREGORY W GOODREAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
17350 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL 32413-6039
(850) 230-3364
(850) 233-9434
Mailing address
17350 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL 32413-6039
(850) 230-3364
(850) 233-9434
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN13745
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
593484406
TAX ID #
FL
01
—
DN13745
MEDICAL LISCENSE #
FL
Enumeration date
05/04/2007
Last updated
07/08/2007
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