Healthcare Provider Details

I. General information

NPI: 1306306097
Provider Name (Legal Business Name): GOETO DANTES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

III MARINE EXPEDITIONARY FORCE SURGEON UNIT 35605
FPO AP
96382
US

IV. Provider business mailing address

III MARINE EXPEDITIONARY FORCE SURGEON UNIT 35605
FPO AP
96382
US

V. Phone/Fax

Practice location:
  • Phone: 239-877-4356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number92403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: