Provider Demographics
NPI:1326247040
Name:GOEHL, ROBERT R (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:GOEHL
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 1:7675 DAGGET ST
Mailing Address - Street 2:160
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2200
Mailing Address - Country:US
Mailing Address - Phone:858-292-4566
Mailing Address - Fax:858-292-5217
Practice Address - Street 1:7675 DAGGET ST
Practice Address - Street 2:160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2200
Practice Address - Country:US
Practice Address - Phone:858-292-4566
Practice Address - Fax:858-292-5217
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist