Provider Demographics
NPI:1124193099
Name:GOODMAN, JOHN P (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
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 1:1126 N CHURCH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1000
Mailing Address - Country:US
Mailing Address - Phone:336-370-4040
Mailing Address - Fax:336-370-4566
Practice Address - Street 1:1126 N CHURCH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1000
Practice Address - Country:US
Practice Address - Phone:336-370-4040
Practice Address - Fax:336-370-4566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice