Provider Demographics
NPI:1386055325
Name:GOEBEL, KIRK CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:CHARLES
Last Name:GOEBEL
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 1:2817 RIELLY ROAD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY JOEL DENTAL CLINIC
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-643-2196
Mailing Address - Fax:
Practice Address - Street 1:2817 RIELLY ROAD
Practice Address - Street 2:US ARMY DENTAL ACTIVITY JOEL DENTAL CLINIC
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-643-2196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010209291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice