Provider Demographics
NPI:1194552521
Name:GOOD ANESTHESIA SERVICES, LLC
Entity type:Organization
Organization Name:GOOD ANESTHESIA SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODLOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:879-329-1098
Mailing Address - Street 1:5200 S COLONY BLVD UNIT 560181
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-2349
Mailing Address - Country:US
Mailing Address - Phone:870-329-1098
Mailing Address - Fax:
Practice Address - Street 1:2222 FORT WORTH AVE STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1864
Practice Address - Country:US
Practice Address - Phone:945-253-3168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty