Provider Demographics
NPI:1285358887
Name:GOODE, LAUREN CORNELIA (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:CORNELIA
Last Name:GOODE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 MARTIN LUTHER KING JR HWY
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4016
Mailing Address - Country:US
Mailing Address - Phone:954-806-6032
Mailing Address - Fax:240-714-3755
Practice Address - Street 1:7023 MARTIN LUTHER KING JR HWY
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4016
Practice Address - Country:US
Practice Address - Phone:301-882-8888
Practice Address - Fax:240-714-3755
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist