Provider Demographics
NPI:1770669632
Name:GOBLE, HENRY GRADY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:GRADY
Last Name:GOBLE
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 1:224 SHALLOWFORD RD NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-4171
Mailing Address - Country:US
Mailing Address - Phone:770-536-1170
Mailing Address - Fax:
Practice Address - Street 1:224 SHALLOWFORD RD NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-4171
Practice Address - Country:US
Practice Address - Phone:770-536-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9932 GA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice