MEDICARE: DR. JAMES DONALD GOFORTH D.D.S.

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	22968	CA

General Provider Information

NPI Number	:	1487863981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DONALD GOFORTH D.D.S.

Provider Business Mailing Address
First Line	:	3742 KATELLA AVE
Second Line	:	SUITE 301
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3102
Country	:	US
Telephone Number	:	562-594-3838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3742 KATELLA AVE
Second Line	:	SUITE 301
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3102
Country	:	US
Telephone Number	:	562-594-3838
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	09/02/2011

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