Provider Demographics
NPI:1497115273
Name:MATTHEW PHILLIP GOODRICH
Entity Type:Organization
Organization Name:MATTHEW PHILLIP GOODRICH
Other - Org Name:GOODRICH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-693-1977
Mailing Address - Street 1:125 MURRAY HILL RD
Mailing Address - Street 2:STE G
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-6354
Mailing Address - Country:US
Mailing Address - Phone:910-693-1977
Mailing Address - Fax:910-693-1877
Practice Address - Street 1:125 MURRAY HILL RD
Practice Address - Street 2:STE G
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6354
Practice Address - Country:US
Practice Address - Phone:910-693-1977
Practice Address - Fax:910-693-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10153122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty