Provider Demographics
NPI:1821158502
Name:GOODRICH, MICHELLE POTTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:POTTER
Last Name:GOODRICH
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 1:510 DAY BREAK SQ
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3453
Mailing Address - Country:US
Mailing Address - Phone:336-282-2009
Mailing Address - Fax:
Practice Address - Street 1:3008 S CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5686
Practice Address - Country:US
Practice Address - Phone:336-584-7004
Practice Address - Fax:336-584-3515
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995749Medicaid
NC95749OtherBCBS
NC5064324OtherAETNA