Provider Demographics
NPI:1982737094
Name:GOODIS, ROBERT K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:GOODIS
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 1:5555 DEL AMO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2307
Mailing Address - Country:US
Mailing Address - Phone:562-866-1735
Mailing Address - Fax:562-866-8190
Practice Address - Street 1:5555 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-2307
Practice Address - Country:US
Practice Address - Phone:562-866-1735
Practice Address - Fax:562-866-8190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice