Provider Demographics
NPI:1497975825
Name:GOOD, DAVID L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:GOOD
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 1:19245 CASA PL
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4423
Mailing Address - Country:US
Mailing Address - Phone:818-881-3688
Mailing Address - Fax:818-881-8199
Practice Address - Street 1:19245 CASA PL
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4423
Practice Address - Country:US
Practice Address - Phone:818-881-3688
Practice Address - Fax:818-881-8199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147621223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB1476201OtherDENTICAL PROVDER NUMBER