Provider Demographics
NPI:1992809297
Name:GOAD, KERRY M (DDS)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:M
Last Name:GOAD
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 1:2400 LAKESIDE BLVD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4346
Mailing Address - Country:US
Mailing Address - Phone:972-690-6653
Mailing Address - Fax:972-680-8757
Practice Address - Street 1:2400 LAKESIDE BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4346
Practice Address - Country:US
Practice Address - Phone:972-690-6653
Practice Address - Fax:972-680-8757
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist