Provider Demographics
NPI:1972037331
Name:GOODALL, ELIZABETH BLAIR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:GOODALL
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 1:2155 UNIVERSITY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1224
Mailing Address - Country:US
Mailing Address - Phone:469-598-1070
Mailing Address - Fax:
Practice Address - Street 1:2155 UNIVERSITY DR STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1224
Practice Address - Country:US
Practice Address - Phone:469-598-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33819122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist