Provider Demographics
NPI:1639149834
Name:GOODOVE, SCOTT ROBBINS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROBBINS
Last Name:GOODOVE
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 1:1127 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2402
Mailing Address - Country:US
Mailing Address - Phone:757-412-2002
Mailing Address - Fax:757-412-2003
Practice Address - Street 1:1127 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2402
Practice Address - Country:US
Practice Address - Phone:757-412-2002
Practice Address - Fax:757-412-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA40105481223S0112X
VA04014105481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery