Provider Demographics
NPI:1407918972
Name:GODING, GREGORY LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:GODING
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 1:49 FARM VIEW DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-5104
Mailing Address - Country:US
Mailing Address - Phone:207-688-4640
Mailing Address - Fax:
Practice Address - Street 1:49 FARM VIEW DR
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260-5104
Practice Address - Country:US
Practice Address - Phone:207-688-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024804L1223G0001X
MEDEN 35921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice