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General NPI Number Information
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NPI Number | 1306939228
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Entity Type | Organization
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Legal Business Name | V RUSSELL GOELLER III MD PA
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 2115 W NINE MILE RD SUITE 1
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City | PENSACOLA
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State | FL
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Zip | 32534-9470
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Country | US
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Telephone | 850-474-1855
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Fax | 850-478-2845
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Provider Business Mailing Address
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Address Line | 2115 W NINE MILE RD SUITE 1
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City | PENSACOLA
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State | FL
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Zip | 32534-9470
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Country | US
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Telephone | 850-474-1855
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Fax | 850-478-2845
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Authorized Official
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Title or Position | PRESIDENT SECRETARY
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Name | VICTOR RUSSELL GOELLER III
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Credential | DMD
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Telephone | 850-474-1855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15157
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License Number State | FL
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