Healthcare Provider Details

I. General information

NPI: 1639149834
Provider Name (Legal Business Name): SCOTT ROBBINS GOODOVE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
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: 757-412-2003
Mailing address:
  • Phone: 757-412-2002
  • Fax: 757-412-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401410548
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4010548
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: