Healthcare Provider Details

I. General information

NPI: 1003332867
Provider Name (Legal Business Name): BRANDON CASEY GOOCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: B. CASEY GOOCH DMD

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 N 48TH ST STE C
SPRINGDALE AR
72762-1054
US

IV. Provider business mailing address

1163 N 48TH ST STE C
SPRINGDALE AR
72762-1054
US

V. Phone/Fax

Practice location:
  • Phone: 479-255-5437
  • Fax: 479-255-5439
Mailing address:
  • Phone: 479-255-5437
  • Fax: 479-255-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4800
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number33285
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62476
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2021028134
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: