Provider Demographics
NPI:1366556367
Name:GOODWILL, DAVID MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:GOODWILL
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 1:3200A VILLA LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3017
Mailing Address - Country:US
Mailing Address - Phone:707-255-5700
Mailing Address - Fax:707-253-2158
Practice Address - Street 1:3200A VILLA LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3017
Practice Address - Country:US
Practice Address - Phone:707-255-5700
Practice Address - Fax:707-253-2158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice