Individual
DR. LARRY EDWARD GOEDECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD LLC
Contact information
Practice address
257 NE 2ND ST, PRINEVILLE, OR 97754
(541) 447-5838
(541) 447-5883
Mailing address
257 NE 2ND ST, PRINEVILLE, OR 97754
(541) 447-5838
(541) 447-5883
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4325
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069781
OMAP
OR
Enumeration date
11/09/2006
Last updated
07/08/2007
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