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NPI Code Detail

MEDICARE: LAURA ELIZABETH GOODELL D.M.D.

MEDICARE: LAURA ELIZABETH GOODELL D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric Dentistry30-023846OH
21223P0221XPediatric Dentistry1001695WI

General Provider Information

NPI Number : 1346535002
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ELIZABETH GOODELL D.M.D.
Provider Business Mailing Address
First Line : N97W14947 BURNING BUSH CT
Second Line :
City : GERMANTOWN
State : WI
Zip : 53022-6628
Country : US
Telephone Number : 608-712-8195
Fax Number :
Provider Business Practice Location Address
First Line : 2100 MILLER PARK WAY
Second Line :
City : WEST MILWAUKEE
State : WI
Zip : 53219-1641
Country : US
Telephone Number : 262-436-3363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2011
Last Update Date : 03/17/2018

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