Provider Demographics
NPI:1083821524
Name:GOATES, LARRY J (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:GOATES
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2252
Mailing Address - Country:US
Mailing Address - Phone:817-988-1961
Mailing Address - Fax:817-801-4908
Practice Address - Street 1:422 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2252
Practice Address - Country:US
Practice Address - Phone:817-465-2300
Practice Address - Fax:817-801-4908
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics