Provider Demographics
NPI:1598083305
Name:GODDARD, ADAM CLAYTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:CLAYTON
Last Name:GODDARD
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 1:901 VALLEY VIEW BLVD # 100
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-6363
Mailing Address - Country:US
Mailing Address - Phone:814-946-5060
Mailing Address - Fax:
Practice Address - Street 1:901 VALLEY VIEW BLVD # 100
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-6363
Practice Address - Country:US
Practice Address - Phone:814-946-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002021841223S0112X
PADS0405761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery