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General NPI Number Information
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NPI Number | 1649436478
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Entity Type | Organization
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Legal Business Name | MARK A. GOODFELLOW, D.D.S., INC.
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 2427 N TUSTIN AVE STE A
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City | SANTA ANA
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State | CA
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Zip | 92705-1655
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Country | US
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Telephone | 714-647-9339
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Fax | 714-647-9576
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Provider Business Mailing Address
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Address Line | 2427 N TUSTIN AVE STE A
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City | SANTA ANA
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State | CA
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Zip | 92705-1655
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Country | US
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Telephone | 714-647-9339
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Fax | 714-647-9576
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Authorized Official
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Title or Position | OFFICE MGR
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Name | LINDA OCHS
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Credential |
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Telephone | 714-647-9339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 30534
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License Number State | CA
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