Basic Information
| Provider Information | |||||||||
| NPI: | 1932120326 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOODLESS | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 470396 | ||||||||
| Address2: | |||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347470396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075661616 | ||||||||
| FaxNumber: | 4075661617 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 CELEBRATION PL | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | CELEBRATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347475433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4075661616 | ||||||||
| FaxNumber: | 4075661617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | ME0058612 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology | 207NS0135X | ME0058612 | FL | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
No ID Information.