Provider Demographics
NPI:1851475081
Name:GOODSELL, THOMAS CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHARLES
Last Name:GOODSELL
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 1:131 E. COLUMBIA AVE.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3761
Mailing Address - Country:US
Mailing Address - Phone:269-963-7767
Mailing Address - Fax:269-963-4380
Practice Address - Street 1:131 E. COLUMBIA AVE.
Practice Address - Street 2:SUITE 210
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3761
Practice Address - Country:US
Practice Address - Phone:269-963-7767
Practice Address - Fax:269-963-4380
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010131501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1544787Medicaid