Provider Demographics
NPI:1811233729
Name:YVONNE GOFF DDS INC
Entity Type:Organization
Organization Name:YVONNE GOFF DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-458-0800
Mailing Address - Street 1:1304 15TH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1813
Mailing Address - Country:US
Mailing Address - Phone:310-458-0800
Mailing Address - Fax:310-458-0803
Practice Address - Street 1:1304 15TH ST STE 403
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1813
Practice Address - Country:US
Practice Address - Phone:310-458-0800
Practice Address - Fax:310-458-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty