Provider Demographics
NPI:1003332867
Name:GOOCH, BRANDON CASEY (DMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:CASEY
Last Name:GOOCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:B.
Other - Middle Name:CASEY
Other - Last Name:GOOCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2817 LOOP 250 FRONTAGE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 E ZORA ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-9770
Practice Address - Country:US
Practice Address - Phone:417-228-8286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332851223P0221X
MO20210281341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty