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General NPI Number Information
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NPI Number | 1235267774
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Entity Type | Individual
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Provider Name | CHARLES JOSEPH GOODACRE DDS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 11092 ANDERSON ST DEAN'S OFFICE, PH 5518
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City | LOMA LINDA
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State | CA
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Zip | 92350-1706
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Country | US
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Telephone | 909-558-4683
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Fax | 909-558-0483
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Provider Business Mailing Address
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Address Line | 250 EAST 7TH STREET SUITE D
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-558-4683
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Fax | 909-558-0483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 42510
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License Number State | CA
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