Healthcare Provider Details

I. General information

NPI: 1992690556
Provider Name (Legal Business Name): HOLLY MARIE GOODREAU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 WESTERN BRANCH BLVD
CHESAPEAKE VA
23321-5219
US

IV. Provider business mailing address

3221 WESTERN BRANCH BLVD
CHESAPEAKE VA
23321-5219
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14220
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: