| Organization Name: | GOODING FAMILY DENTAL |
| NPI Number: | 1568755304 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DUSTIN NAVARRO (DENTIST) |
| Mailing Address: | 325 Main St Gooding |
| State: | ID US |
| Postal Code: | 833301302 |
| Phone Number: | 2089348080 |
| Fax Number: | 2089349756 |
| NPI Enumeration Date: | 05/26/2011 |
| NPI Last Update Date: | 05/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 4355 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |