Provider Demographics
NPI:1235267774
Name:GOODACRE, CHARLES JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:GOODACRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EAST 7TH STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-558-4683
Mailing Address - Fax:909-558-0483
Practice Address - Street 1:11092 ANDERSON ST
Practice Address - Street 2:DEAN'S OFFICE, PH 5518
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1706
Practice Address - Country:US
Practice Address - Phone:909-558-4683
Practice Address - Fax:909-558-0483
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA149710156OtherAMER. DENTAL ASSOC. #
CA42510OtherCALIF. DENTAL ASSOC. #