Provider Demographics
NPI:1689846438
Name:GOEBEL, GARY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:GOEBEL
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 1:7017 JOHN DEERE PKWY
Mailing Address - Street 2:SUITE 2 B POB 1266
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8072
Mailing Address - Country:US
Mailing Address - Phone:309-278-0345
Mailing Address - Fax:309-278-0347
Practice Address - Street 1:7017 JOHN DEERE PKWY
Practice Address - Street 2:SUITE 2 B
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8072
Practice Address - Country:US
Practice Address - Phone:309-278-0345
Practice Address - Fax:309-278-0347
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist