Healthcare Provider Details

I. General information

NPI: 1538889803
Provider Name (Legal Business Name): VON GOODIN DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W OLIVE AVE
MERCED CA
95348-2420
US

IV. Provider business mailing address

830 W OLIVE AVE
MERCED CA
95348-2420
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-3434
  • Fax: 209-384-8262
Mailing address:
  • Phone: 209-384-3434
  • Fax: 209-384-8262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAVON GOODIN
Title or Position: OWNER
Credential: DDS
Phone: 209-384-3434