Provider Demographics
NPI:1679791354
Name:GOODALE, CHARLOTTE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ANN
Last Name:GOODALE
Suffix:
Gender:F
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:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:COMFORT
Mailing Address - State:TX
Mailing Address - Zip Code:78013-0537
Mailing Address - Country:US
Mailing Address - Phone:830-995-4050
Mailing Address - Fax:830-995-4052
Practice Address - Street 1:#14 HWY 87
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013
Practice Address - Country:US
Practice Address - Phone:830-995-4050
Practice Address - Fax:830-995-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist