Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 33285 | TX |
NPI | 1003332867 |
---|---|
Provider Name | Brandon Casey Gooch |
First Address | Midland, TX 79705 |
Second Address | Midland, TX 79705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/08/2017 |