Provider Demographics
NPI:1487949053
Name:GOGGIN, SUSANNA MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:MARIE
Last Name:GOGGIN
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 1:602 ALLIANCE CT
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2338
Mailing Address - Country:US
Mailing Address - Phone:828-665-4405
Mailing Address - Fax:828-665-4407
Practice Address - Street 1:602 ALLIANCE CT
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2338
Practice Address - Country:US
Practice Address - Phone:828-665-4405
Practice Address - Fax:828-665-4407
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9019122300000X
NC99261223P0300X
NC2601211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist