Healthcare Provider Details

I. General information

NPI: 1760488977
Provider Name (Legal Business Name): DR. DAREN LANE GOIN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N 2ND AVE
STAYTON OR
97383-1715
US

IV. Provider business mailing address

505 N 2ND AVE
STAYTON OR
97383-1715
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-3366
  • Fax: 503-769-5501
Mailing address:
  • Phone: 503-769-3366
  • Fax: 503-769-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5179
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: