Provider Demographics
NPI:1770698409
Name:GOBLE, RICHARD G (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:GOBLE
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 1:1108 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3325
Mailing Address - Country:US
Mailing Address - Phone:760-728-2261
Mailing Address - Fax:760-728-2313
Practice Address - Street 1:1108 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3325
Practice Address - Country:US
Practice Address - Phone:760-728-2261
Practice Address - Fax:760-728-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice