Provider Demographics
NPI:1598482747
Name:GOODREAU, ASHTYN (DMD, MS)
Entity Type:Individual
Prefix:
First Name:ASHTYN
Middle Name:
Last Name:GOODREAU
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HORIZON DRIVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3970
Mailing Address - Country:US
Mailing Address - Phone:215-997-0200
Mailing Address - Fax:215-997-0659
Practice Address - Street 1:1300 HORIZON DRIVE
Practice Address - Street 2:SUITE 117
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3970
Practice Address - Country:US
Practice Address - Phone:215-997-0200
Practice Address - Fax:215-997-0659
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0438971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty