Healthcare Provider Details

I. General information

NPI: 1205784626
Provider Name (Legal Business Name): GOS VIRGINIA BEACH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 FIRST COLONIAL RD
VIRGINIA BEACH VA
23451-6195
US

IV. Provider business mailing address

837 FIRST COLONIAL RD
VIRGINIA BEACH VA
23451-6195
US

V. Phone/Fax

Practice location:
  • Phone: 757-412-2002
  • Fax:
Mailing address:
  • Phone: 757-412-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GOODOVE
Title or Position: CEO
Credential: DDS
Phone: 757-412-2002