Provider Demographics
NPI:1326106600
Name:GOODE, ROBERT LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:GOODE
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 1:21599 W 11 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3800
Mailing Address - Country:US
Mailing Address - Phone:248-354-0000
Mailing Address - Fax:248-354-2198
Practice Address - Street 1:21599 W 11 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3800
Practice Address - Country:US
Practice Address - Phone:248-354-0000
Practice Address - Fax:248-354-2198
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010153761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice