Provider Demographics
NPI:1205195419
Name:GOOT, ARNOLD L (DDS)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:L
Last Name:GOOT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ARNOLD
Other - Middle Name:L
Other - Last Name:GOOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:25 E WASHINGTON ST
Mailing Address - Street 2:SUITE 1211
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1708
Mailing Address - Country:US
Mailing Address - Phone:312-263-5090
Mailing Address - Fax:312-263-5131
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:SUITE 1211
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:312-263-5090
Practice Address - Fax:312-263-5131
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist