Provider Demographics
NPI:1629075858
Name:GOETTL, JAMES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:GOETTL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2531 BRIARCLIFF RD NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3017
Mailing Address - Country:US
Mailing Address - Phone:404-634-4224
Mailing Address - Fax:404-634-4224
Practice Address - Street 1:2531 BRIARCLIFF RD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:404-634-4224
Practice Address - Fax:404-634-4224
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice