Provider Demographics
NPI:1295021988
Name:GOEBEL, DREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:
Last Name:GOEBEL
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 1:407 E AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3942
Mailing Address - Country:US
Mailing Address - Phone:701-258-8509
Mailing Address - Fax:
Practice Address - Street 1:407 E AVENUE C
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3942
Practice Address - Country:US
Practice Address - Phone:701-258-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21591223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry