Provider Demographics
NPI:1285658005
Name:GOODMAN, CRAIG STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STUART
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 1:5925 FOREST LN
Mailing Address - Street 2:SUITE #310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2712
Mailing Address - Country:US
Mailing Address - Phone:972-233-1142
Mailing Address - Fax:972-960-1411
Practice Address - Street 1:5925 FOREST LN
Practice Address - Street 2:SUITE #310
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2712
Practice Address - Country:US
Practice Address - Phone:972-233-1142
Practice Address - Fax:972-960-1411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics