Provider Demographics
NPI:1154089837
Name:GOODCHILD, RHONDA BALDWIN
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:BALDWIN
Last Name:GOODCHILD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 PILGRIM LN
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1851
Mailing Address - Country:US
Mailing Address - Phone:610-764-8886
Mailing Address - Fax:
Practice Address - Street 1:1231 PILGRIM LN
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-1851
Practice Address - Country:US
Practice Address - Phone:610-764-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000908124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty