Provider Demographics
NPI:1932120326
Name:GOODLESS, DEAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:R
Last Name:GOODLESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470396
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-0396
Mailing Address - Country:US
Mailing Address - Phone:407-566-1616
Mailing Address - Fax:407-566-1617
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:SUITE 301
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5433
Practice Address - Country:US
Practice Address - Phone:407-566-1616
Practice Address - Fax:407-566-1617
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058612207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF76245Medicare UPIN
FL23946CMedicare ID - Type UnspecifiedCELEBRATION OFFICE MCR #