Provider Demographics
NPI:1144421678
Name:DR. ALVIN S. GOODMAN, P.A.
Entity Type:Organization
Organization Name:DR. ALVIN S. GOODMAN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSCD
Authorized Official - Phone:704-366-3452
Mailing Address - Street 1:3535 RANDOLPH RD
Mailing Address - Street 2:SUITE R-101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1032
Mailing Address - Country:US
Mailing Address - Phone:704-366-3452
Mailing Address - Fax:704-366-3065
Practice Address - Street 1:3535 RANDOLPH RD.
Practice Address - Street 2:SUITE R-101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1032
Practice Address - Country:US
Practice Address - Phone:704-366-3452
Practice Address - Fax:704-366-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty