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NPI Code Detail

MEDICARE: DR. HENRY GRADY GOBLE D.D.S.

MEDICARE:  DR. HENRY GRADY GOBLE  D.D.S.
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
11223G0001XGeneral Practice Dentistry9932 GAGA

General Provider Information

NPI Number : 1770669632
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENRY GRADY GOBLE D.D.S.
Provider Business Mailing Address
First Line : 224 SHALLOWFORD RD NW
Second Line :
City : GAINESVILLE
State : GA
Zip : 30504-4171
Country : US
Telephone Number : 770-536-1170
Fax Number :
Provider Business Practice Location Address
First Line : 224 SHALLOWFORD RD NW
Second Line :
City : GAINESVILLE
State : GA
Zip : 30504-4171
Country : US
Telephone Number : 770-536-1170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 07/08/2007

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Directions to “ DR. HENRY GRADY GOBLE D.D.S.” Practice Location

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