Provider Demographics
NPI:1093894578
Name:GOEBEL, THOMAS MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:GOEBEL
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 1:110 ROWLEY DR
Mailing Address - Street 2:
Mailing Address - City:STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06378-2022
Mailing Address - Country:US
Mailing Address - Phone:860-912-9323
Mailing Address - Fax:
Practice Address - Street 1:491 GOLD STAR HWY STE 200
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6226
Practice Address - Country:US
Practice Address - Phone:860-446-2357
Practice Address - Fax:860-446-2359
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT89041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics