Provider Demographics
NPI:1043426273
Name:GOODMAN, LINDA ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3679 WOODVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2670
Mailing Address - Country:US
Mailing Address - Phone:248-360-9372
Mailing Address - Fax:
Practice Address - Street 1:8010 N MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1808
Practice Address - Country:US
Practice Address - Phone:734-421-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0152481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4344592Medicaid