Provider Demographics
NPI:1083811277
Name:GOODMAN, BRIAN JOSEPH (D,D,S)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:D,D,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 E DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-7077
Mailing Address - Country:US
Mailing Address - Phone:480-830-6619
Mailing Address - Fax:480-807-4002
Practice Address - Street 1:18610 E. RITTENHOUSE RD.
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242
Practice Address - Country:US
Practice Address - Phone:480-807-4000
Practice Address - Fax:480-807-4002
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist