Provider Demographics
NPI:1952757379
Name:BRITTANY D GOODING DDS PC
Entity Type:Organization
Organization Name:BRITTANY D GOODING DDS PC
Other - Org Name:CROWN HILL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-832-7741
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47842-0408
Mailing Address - Country:US
Mailing Address - Phone:765-832-7741
Mailing Address - Fax:765-832-7743
Practice Address - Street 1:1792 E STATE ROAD 163
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-7327
Practice Address - Country:US
Practice Address - Phone:765-832-7741
Practice Address - Fax:765-832-7743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011674A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty