Provider Demographics
NPI:1871178962
Name:GOODE, XAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:
Last Name:GOODE
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 1:1104 JOANNA AVE
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3306
Mailing Address - Country:US
Mailing Address - Phone:214-384-8748
Mailing Address - Fax:
Practice Address - Street 1:605 AVALON DR
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-3034
Practice Address - Country:US
Practice Address - Phone:972-287-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice