Healthcare Provider Details

I. General information

NPI: 1689725780
Provider Name (Legal Business Name): JOSEPH F GOODSELL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1146 N BRAND BLVD
GLENDALE CA
91202-2504
US

IV. Provider business mailing address

2020 LYANS DR
LA CANADA CA
91011-1537
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-4217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: