Provider Demographics
NPI:1356304422
Name:GOYMERAC, BRETT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:S
Last Name:GOYMERAC
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 1:16 HEATHER LN
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9396
Mailing Address - Country:US
Mailing Address - Phone:906-249-1390
Mailing Address - Fax:
Practice Address - Street 1:760 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4138
Practice Address - Country:US
Practice Address - Phone:906-228-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI178421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice