MEDICARE: HENRY G. GOBLE, D.D.S., P.C.

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	9932	GA

General Provider Information

NPI Number	:	1437355740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY G. GOBLE, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	224 SHALLOWFORD RD NW
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-4171
Country	:	US
Telephone Number	:	770-536-1170
Fax Number	:	770-536-4653

Provider Business Practice Location Address
First Line	:	224 SHALLOWFORD RD NW
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-4171
Country	:	US
Telephone Number	:	770-536-1170
Fax Number	:	770-536-4653

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HENRY GRADY GOBLE
Credential	:	D.D.S.
Telephone Number	:	770-536-1170

Provider Enumeration Date	:	06/23/2007
Last Update Date	:	08/22/2020

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