Provider Demographics
NPI:1205190477
Name:GOODE, AMBER K (RDH, DDS)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:K
Last Name:GOODE
Suffix:
Gender:F
Credentials:RDH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGHGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4294
Mailing Address - Country:US
Mailing Address - Phone:703-517-5575
Mailing Address - Fax:
Practice Address - Street 1:3245 LAWRENCEVILLE SUWANEE RD STE 100
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6541
Practice Address - Country:US
Practice Address - Phone:703-517-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014134341223G0001X
DCDEN10010781223G0001X
GADN1222251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice