Provider Demographics
NPI:1942384458
Name:GOODCHILD, DAVID GEORGE JR (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:GOODCHILD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-457-5848
Mailing Address - Fax:770-457-5846
Practice Address - Street 1:4700 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:200
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-457-5848
Practice Address - Fax:770-457-5846
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice