Provider Demographics
NPI:1972750362
Name:GOGGANS, GREGORY G (DMD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:GOGGANS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 PETERSON AVE N
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3708
Mailing Address - Country:US
Mailing Address - Phone:912-384-1560
Mailing Address - Fax:912-384-6576
Practice Address - Street 1:114 PETERSON AVE N
Practice Address - Street 2:SUITE 305
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3708
Practice Address - Country:US
Practice Address - Phone:912-384-1560
Practice Address - Fax:912-384-6576
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000100251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics