Active NPI
Charles Joseph Goodacre, DDS
- Prosthodontics
- Loma Linda, CA
National Provider Identifier
1235267774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 42510
- Practice address
- 11092 Anderson St
Dean'S Office, PH 5518
Loma Linda, CA 92350-1706 - Phone
- (909) 558-4683
- Fax
- (909) 558-0483
- NPI assigned
- Feb 28, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 42510 | CA | Primary |
Addresses
Primary practice location
11092 Anderson St
Dean'S Office, PH 5518
Loma Linda, CA 92350-1706
Mailing address
250 East 7TH Street
Suite D
Upland, CA 91786
Phone (909) 558-4683
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 149710156 | Other | CA | AMER. DENTAL ASSOC. # |
| 42510 | Other | CA | CALIF. DENTAL ASSOC. # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596585600000",
"number": "1235267774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 EAST 7TH STREET",
"address_2": "SUITE D",
"city": "UPLAND",
"state": "CA",
"postal_code": "91786",
"telephone_number": "909-558-4683",
"fax_number": "909-558-0483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11092 ANDERSON ST",
"address_2": "DEAN'S OFFICE, PH 5518",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501706",
"telephone_number": "909-558-4683",
"fax_number": "909-558-0483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODACRE",
"first_name": "CHARLES",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2020-08-05",
"certification_date": "2020-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CA",
"license": "42510",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMER. DENTAL ASSOC. #",
"identifier": "149710156",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIF. DENTAL ASSOC. #",
"identifier": "42510",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.