Provider Demographics
NPI:1023112240
Name:GOODE, TODD EDWARDS (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:EDWARDS
Last Name:GOODE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 POOLA ST
Mailing Address - Street 2:
Mailing Address - City:HONALULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821
Mailing Address - Country:US
Mailing Address - Phone:808-377-1191
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 1304
Practice Address - City:HONALULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-955-0004
Practice Address - Fax:808-949-3204
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice