Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 42510 | CA |
NPI | 1235267774 |
---|---|
Provider Name | Dr. Charles Joseph Goodacre |
First Address | Upland, CA 91786 |
Second Address | Loma Linda, CA 92350-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 05/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149710156 | AMER. DENTAL ASSOC. # (01) | CA |
42510 | CALIF. DENTAL ASSOC. # (01) | CA |