Provider Demographics
NPI:1942693296
Name:DR. BURTON GOOCH
Entity Type:Organization
Organization Name:DR. BURTON GOOCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-991-9892
Mailing Address - Street 1:6807 TATTERSAL WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4237
Mailing Address - Country:US
Mailing Address - Phone:205-991-9892
Mailing Address - Fax:205-991-9722
Practice Address - Street 1:6807 TATTERSAL WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4237
Practice Address - Country:US
Practice Address - Phone:205-991-9892
Practice Address - Fax:205-991-9722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX IDENTIFICATION