MEDICARE: DR. SCOTT ROBBINS GOODOVE 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4010548	VA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401410548	VA

General Provider Information

NPI Number	:	1639149834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT ROBBINS GOODOVE DDS

Provider Business Mailing Address
First Line	:	1127 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2402
Country	:	US
Telephone Number	:	757-412-2002
Fax Number	:	757-412-2003

Provider Business Practice Location Address
First Line	:	1127 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2402
Country	:	US
Telephone Number	:	757-412-2002
Fax Number	:	757-412-2003

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	05/23/2018

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