Healthcare Provider Details

I. General information

NPI: 1952233140
Provider Name (Legal Business Name): ERIN MAE GOODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 RANGE LINE ST STE 111
COLUMBIA MO
65202-1618
US

IV. Provider business mailing address

2601 RANGE LINE ST STE 111
COLUMBIA MO
65202-1618
US

V. Phone/Fax

Practice location:
  • Phone: 573-355-5870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026023667
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: