Provider Demographics
NPI:1932802824
Name:DAVID L GOETTEE D.D.S., P.C.
Entity Type:Organization
Organization Name:DAVID L GOETTEE D.D.S., P.C.
Other - Org Name:WEST COBB DENTISTRY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-794-3332
Mailing Address - Street 1:5255 STILESBORO RD NW STE 150
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7738
Mailing Address - Country:US
Mailing Address - Phone:770-794-3332
Mailing Address - Fax:770-794-2304
Practice Address - Street 1:5255 STILESBORO RD NW STE 150
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7738
Practice Address - Country:US
Practice Address - Phone:770-794-3332
Practice Address - Fax:770-794-2304
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID L GOETTEE, D.D.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-22
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty