Provider Demographics
NPI:1790999340
Name:ROBERT GOODIS DDS AND NATE WEINER DDS
Entity Type:Organization
Organization Name:ROBERT GOODIS DDS AND NATE WEINER DDS
Other - Org Name:LAKEWOOD DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOODIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-866-1735
Mailing Address - Street 1:5555 DEL AMO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2307
Mailing Address - Country:US
Mailing Address - Phone:562-866-1735
Mailing Address - Fax:562-866-8190
Practice Address - Street 1:5555 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-2307
Practice Address - Country:US
Practice Address - Phone:562-866-1735
Practice Address - Fax:562-866-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty