Provider Demographics
NPI:1265689673
Name:GOODIN & MARTENS, DDS, PC
Entity Type:Organization
Organization Name:GOODIN & MARTENS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:417-869-6487
Mailing Address - Street 1:3850 SOUTH NATIONAL AVE,
Mailing Address - Street 2:HULSTON CANCER CENTER SUITE 720
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-869-6487
Mailing Address - Fax:417-269-7549
Practice Address - Street 1:3850 SOUTH NATIONAL AVE,
Practice Address - Street 2:HULSTON CANCER CENTER SUITE 720
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-869-6487
Practice Address - Fax:417-269-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015922122300000X
MO011444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty