Provider Demographics
NPI:1154427292
Name:GOODALL, DEAN ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:ALLEN
Last Name:GOODALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 TIMBERLACHEN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3395
Mailing Address - Country:US
Mailing Address - Phone:407-330-3801
Mailing Address - Fax:407-330-5739
Practice Address - Street 1:114 TIMBERLACHEN CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3395
Practice Address - Country:US
Practice Address - Phone:407-330-3801
Practice Address - Fax:407-330-5739
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN78601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice