MEDICARE: DR. WILLIAM M GOEBEL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1437143732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM M GOEBEL DDS

Provider Business Mailing Address
First Line	:	1705 SEMINOLE LN
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035-1542
Country	:	US
Telephone Number	:	618-466-4320
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 S 2ND ST
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2006
Country	:	US
Telephone Number	:	618-254-9813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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