Provider Demographics
NPI:1871716381
Name:GOODIN, STANLEY E (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:GOODIN
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 1:554-850 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0519
Mailing Address - Country:US
Mailing Address - Phone:530-294-5629
Mailing Address - Fax:530-294-5120
Practice Address - Street 1:554-850 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIEBER
Practice Address - State:CA
Practice Address - Zip Code:96009-0519
Practice Address - Country:US
Practice Address - Phone:530-294-5629
Practice Address - Fax:530-294-5120
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA249801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice