Basic Information
Provider Information
NPI: 1033559737
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOACHER
FirstName: STEVEN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1171 HIGHWAY 62 412
Address2:  
City: ASH FLAT
State: AR
PostalCode: 725139612
CountryCode: US
TelephoneNumber: 8709947645
FaxNumber: 8709943566
Practice Location
Address1: 1171 HIGHWAY 62 412
Address2:  
City: ASH FLAT
State: AR
PostalCode: 725139612
CountryCode: US
TelephoneNumber: 8709947645
FaxNumber: 8709943566
Other Information
ProviderEnumerationDate: 06/27/2013
LastUpdateDate: 06/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X3943ARY Dental ProvidersDentist 

No ID Information.


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