Provider Demographics
NPI:1700971710
Name:GOATES, JAMES B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:GOATES
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 1:1508 N GRANDVIEW AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3000
Mailing Address - Country:US
Mailing Address - Phone:432-367-8907
Mailing Address - Fax:432-362-0949
Practice Address - Street 1:1508 N GRANDVIEW AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-3000
Practice Address - Country:US
Practice Address - Phone:432-367-8907
Practice Address - Fax:432-362-0949
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice