Provider Demographics
NPI:1336579135
Name:MEREDITH GOODRICH DMD, PA
Entity Type:Organization
Organization Name:MEREDITH GOODRICH DMD, PA
Other - Org Name:ERBES & GOODRICH DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-375-3758
Mailing Address - Street 1:2121 NW 40TH TER
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5813
Mailing Address - Country:US
Mailing Address - Phone:352-375-3758
Mailing Address - Fax:
Practice Address - Street 1:2121 NW 40TH TER
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5813
Practice Address - Country:US
Practice Address - Phone:352-375-3758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN161171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty