Provider Demographics
NPI:1073769980
Name:GOODMAN, JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:GOODMAN
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:P.O. BOX 249
Mailing Address - Street 2:3900 TEN OAKS RD.
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737
Mailing Address - Country:US
Mailing Address - Phone:410-531-6600
Mailing Address - Fax:410-988-9261
Practice Address - Street 1:3900 TEN OAKS RD.
Practice Address - Street 2:
Practice Address - City:GLENELG
Practice Address - State:MD
Practice Address - Zip Code:21737
Practice Address - Country:US
Practice Address - Phone:410-531-6600
Practice Address - Fax:410-988-9261
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD69881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice