MEDICARE: DONALD C. GOECKEL, 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	10127	MI

General Provider Information

NPI Number	:	1609027507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD C. GOECKEL, D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	3433 E MIDLAND RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2825
Country	:	US
Telephone Number	:	989-686-6110
Fax Number	:	989-686-6170

Provider Business Practice Location Address
First Line	:	3433 E MIDLAND RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2825
Country	:	US
Telephone Number	:	989-686-6110
Fax Number	:	989-686-6170

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DONALD C. GOECKEL
Credential	:	DDS
Telephone Number	:	989-686-6110

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	10/09/2008

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