Provider Demographics
NPI:1982818670
Name:GOECKEL, DAVID JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JON
Last Name:GOECKEL
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 1:107 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-1531
Mailing Address - Country:US
Mailing Address - Phone:989-224-4712
Mailing Address - Fax:989-834-5581
Practice Address - Street 1:107 SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-1531
Practice Address - Country:US
Practice Address - Phone:989-224-4712
Practice Address - Fax:989-834-5581
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0123341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice