Basic Information
| Provider Information | |||||||||
| NPI: | 1114491016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOEBEL | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | ILEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER AVE | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 876 N VAN DYKE RD | ||||||||
| Address2: | |||||||||
| City: | BAD AXE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484139016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896230137 | ||||||||
| FaxNumber: | 9899214977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2019 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2902018470 | MI | Y | Dental Providers | Dental Hygienist |
No ID Information.