Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 8904 | CT |
NPI | 1093894578 |
---|---|
Provider Name | Dr. Thomas Matthew Goebel |
First Address | Stonington, CT 06378-2022 |
Second Address | Groton, CT 06340-6226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 24/06/2021 |