Provider Demographics
NPI:1740683382
Name:CHRISTINA R. GOODALL, DDS PLLC
Entity type:Organization
Organization Name:CHRISTINA R. GOODALL, DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISITNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-336-5245
Mailing Address - Street 1:2128 HIGH HOUSE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8443
Mailing Address - Country:US
Mailing Address - Phone:919-336-5245
Mailing Address - Fax:919-336-5246
Practice Address - Street 1:2128 HIGH HOUSE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8443
Practice Address - Country:US
Practice Address - Phone:919-336-5245
Practice Address - Fax:919-336-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty