Provider Demographics
NPI:1295874394
Name:GOODALL, JUNE NANCY (DDS)
Entity type:Individual
Prefix:DR
First Name:JUNE
Middle Name:NANCY
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 1:11111 I 10 SUITE 1000
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2120
Mailing Address - Country:US
Mailing Address - Phone:713-461-3200
Mailing Address - Fax:713-461-1880
Practice Address - Street 1:11111 I 10 SUITE 1000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2120
Practice Address - Country:US
Practice Address - Phone:713-461-3200
Practice Address - Fax:713-461-1880
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist