Provider Demographics
NPI:1093845950
Name:GOODYEAR, DAVID DENNY (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:DENNY
Last Name:GOODYEAR
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:COLOMA
Mailing Address - State:MI
Mailing Address - Zip Code:49038-9748
Mailing Address - Country:US
Mailing Address - Phone:269-983-4828
Mailing Address - Fax:269-983-4293
Practice Address - Street 1:1000 MAIN SSTREET
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-983-4828
Practice Address - Fax:269-983-4292
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002334237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist