Provider Demographics
NPI:1346311321
Name:GOEKE, THOMAS F (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:GOEKE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3416
Mailing Address - Country:US
Mailing Address - Phone:859-363-2035
Mailing Address - Fax:859-578-3689
Practice Address - Street 1:610 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3416
Practice Address - Country:US
Practice Address - Phone:859-363-2035
Practice Address - Fax:859-578-3689
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60041175Medicaid