Provider Demographics
NPI:1225250905
Name:GOODMAN, JAMES B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
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 1:27498 NORTHRIDGE RD., PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122
Mailing Address - Country:US
Mailing Address - Phone:509-721-0904
Mailing Address - Fax:
Practice Address - Street 1:605 MARINE AVE
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6928
Practice Address - Country:US
Practice Address - Phone:907-283-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4721223G0001X
MILL5377641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice