Provider Demographics
NPI:1669507737
Name:GOEBBEL, MARTIN GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GEORGE
Last Name:GOEBBEL
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 1:2716 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3741
Mailing Address - Country:US
Mailing Address - Phone:505-892-8600
Mailing Address - Fax:505-892-4215
Practice Address - Street 1:2716 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3741
Practice Address - Country:US
Practice Address - Phone:505-892-8600
Practice Address - Fax:505-892-4215
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD15231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice