Provider Demographics
NPI:1194857573
Name:DAVID J. GOECKEL DDS PC
Entity Type:Organization
Organization Name:DAVID J. GOECKEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JON
Authorized Official - Last Name:GOECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-224-4712
Mailing Address - Street 1:107 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1531
Mailing Address - Country:US
Mailing Address - Phone:989-224-4712
Mailing Address - Fax:
Practice Address - Street 1:107 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1531
Practice Address - Country:US
Practice Address - Phone:989-224-4712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty