Provider Demographics
NPI:1255481552
Name:GOINGS, BRADLEY EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:EUGENE
Last Name:GOINGS
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 1:19062 E WHITAKER PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4950
Mailing Address - Country:US
Mailing Address - Phone:303-690-8003
Mailing Address - Fax:303-690-8003
Practice Address - Street 1:4733 S TIMBERLINE RD STE 101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3023
Practice Address - Country:US
Practice Address - Phone:720-234-5566
Practice Address - Fax:303-690-8003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88341223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics