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General NPI Number Information
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NPI Number | 1790274603
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Entity Type | Organization
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Legal Business Name | GREGORY GOGGANS, D.M.D., P.C.
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 6420 HIGHWAY 11 N STE C
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City | CARRIERE
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State | MS
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Zip | 39426-7146
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Country | US
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Telephone | 601-799-3120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674474
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City | DALLAS
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State | TX
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Zip | 75267-4474
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Country | US
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Telephone | 800-864-1582
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY GOGGANS
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Credential | DMD
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Telephone | 800-864-1582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3983-18
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License Number State | MS
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