Healthcare Provider Details

I. General information

NPI: 1598677593
Provider Name (Legal Business Name): GODDARD FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19931 W KELLOGG DR UNIT C
GODDARD KS
67052-8864
US

IV. Provider business mailing address

19931 W KELLOGG DR UNIT C
GODDARD KS
67052-8864
US

V. Phone/Fax

Practice location:
  • Phone: 316-550-6020
  • Fax: 316-550-6039
Mailing address:
  • Phone: 316-550-6020
  • Fax: 316-550-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC MCANALLY
Title or Position: DENTIST
Credential: DMD
Phone: 316-550-6020