Provider Demographics
NPI:1477678134
Name:GOODRICH, ANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MURRAY HILL RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6354
Mailing Address - Country:US
Mailing Address - Phone:910-693-1977
Mailing Address - Fax:910-639-1877
Practice Address - Street 1:125 MURRAY HILL RD
Practice Address - Street 2:SUITE G
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6354
Practice Address - Country:US
Practice Address - Phone:910-693-1977
Practice Address - Fax:910-639-1877
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice