Provider Demographics
NPI:1871739540
Name:GOODE AND JOHNSON DENTISTRY PARTENRSHIP
Entity type:Organization
Organization Name:GOODE AND JOHNSON DENTISTRY PARTENRSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-725-5500
Mailing Address - Street 1:34301 23 MILE RD
Mailing Address - Street 2:SUITE 140A
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-4432
Mailing Address - Country:US
Mailing Address - Phone:586-725-5500
Mailing Address - Fax:586-725-8172
Practice Address - Street 1:34301 23 MILE RD
Practice Address - Street 2:SUITE 140A
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4432
Practice Address - Country:US
Practice Address - Phone:586-725-5500
Practice Address - Fax:586-725-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195731223G0001X
MI29010123241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty