Provider Demographics
NPI:1568624344
Name:PEDIATRIC DENTISTRY OF STEELE CREEK
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY OF STEELE CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-714-5380
Mailing Address - Street 1:13521 STEELECROFT PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28108
Mailing Address - Country:US
Mailing Address - Phone:704-714-5380
Mailing Address - Fax:
Practice Address - Street 1:13521 STEELECROFT PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28108
Practice Address - Country:US
Practice Address - Phone:704-714-5380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty