Provider Demographics
NPI:1750798542
Name:GOODELL, CHRISTINE BRYANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:BRYANNE
Last Name:GOODELL
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 1:7632 S CAMPUS VIEW DR STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5545
Mailing Address - Country:US
Mailing Address - Phone:801-282-4142
Mailing Address - Fax:
Practice Address - Street 1:7632 S CAMPUS VIEW DR STE 150
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5545
Practice Address - Country:US
Practice Address - Phone:801-282-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202266122300000X
UT104134841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist