Basic Information
| Provider Information | |||||||||
| NPI: | 1558510412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSS-GOODLETT | ||||||||
| FirstName: | SHETEKA | ||||||||
| MiddleName: | KYM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2ND FLOOR BLDG 9900 | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY - FORT LEWIS | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539684039 | ||||||||
| FaxNumber: | 2539685919 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 4250 CLEAR CREEK RD SUITE 213 | ||||||||
| Address2: | |||||||||
| City: | FORT HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542852014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | DE60035929 | WA | N | Dental Providers | Dentist | Pediatric Dentistry | 1223P0221X | 34845 | TX | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.