Provider Demographics
NPI:1437355740
Name:HENRY G. GOBLE, D.D.S., P.C.
Entity type:Organization
Organization Name:HENRY G. GOBLE, D.D.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:GRADY
Authorized Official - Last Name:GOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-536-1170
Mailing Address - Street 1:224 SHALLOWFORD RD NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-4171
Mailing Address - Country:US
Mailing Address - Phone:770-536-1170
Mailing Address - Fax:770-536-4653
Practice Address - Street 1:224 SHALLOWFORD RD NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-4171
Practice Address - Country:US
Practice Address - Phone:770-536-1170
Practice Address - Fax:770-536-4653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty