Basic Information
| Provider Information | |||||||||
| NPI: | 1457919623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOODLESS DERMATOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 CELEBRATION PL STE 301 | ||||||||
| Address2: | |||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075661616 | ||||||||
| FaxNumber: | 4075661617 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 CELEBRATION PL STE 301 | ||||||||
| Address2: | |||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075661616 | ||||||||
| FaxNumber: | 4075661617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2019 | ||||||||
| LastUpdateDate: | 06/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | GOODLESS | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4073617126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.