Provider Demographics
NPI:1821047804
Name:GOFF, JENNIFER N (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:GOFF
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 1:22 VINE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1409
Mailing Address - Country:US
Mailing Address - Phone:260-356-9550
Mailing Address - Fax:260-356-5181
Practice Address - Street 1:22 VINE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1409
Practice Address - Country:US
Practice Address - Phone:260-356-9550
Practice Address - Fax:260-356-5181
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010151122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN164187OtherCHILDREN'S SPECIAL HEALTH