Provider Demographics
NPI:1043498231
Name:SCOTT R GOODOVE DDS PLC
Entity Type:Organization
Organization Name:SCOTT R GOODOVE DDS PLC
Other - Org Name:GOODOVE ORAL SURGERY & DENTAL IMPLANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ROBBINS
Authorized Official - Last Name:GOODOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-412-2002
Mailing Address - Street 1:1127 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2402
Mailing Address - Country:US
Mailing Address - Phone:757-412-2002
Mailing Address - Fax:757-412-2003
Practice Address - Street 1:1127 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2402
Practice Address - Country:US
Practice Address - Phone:757-412-2002
Practice Address - Fax:757-412-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-10
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4014105481223S0112X
VA04014105481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty