Provider Demographics
NPI:1598782229
Name:GOODRICK, DELL ARIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELL
Middle Name:ARIEL
Last Name:GOODRICK
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 1:23504 LYONS AVE
Mailing Address - Street 2:STE #104
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321
Mailing Address - Country:US
Mailing Address - Phone:661-254-4000
Mailing Address - Fax:661-254-8799
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:STE #104
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:661-254-4000
Practice Address - Fax:661-254-8799
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
668805OtherUNITED CONCORDIA