Provider Demographics
NPI:1629043880
Name:GOECKEL, DONALD CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:CHARLES
Last Name:GOECKEL
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 1:3433 E MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2895
Mailing Address - Country:US
Mailing Address - Phone:989-686-6110
Mailing Address - Fax:989-686-6170
Practice Address - Street 1:3433 E MIDLAND RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2895
Practice Address - Country:US
Practice Address - Phone:989-686-6110
Practice Address - Fax:989-686-6170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice