Provider Demographics
NPI:1558570622
Name:GOODHUE, MATTHEW DONOVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DONOVAN
Last Name:GOODHUE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17050 PILKINGTON RD.
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-636-6644
Mailing Address - Fax:503-635-3099
Practice Address - Street 1:17050 PILKINGTON RD.
Practice Address - Street 2:SUITE 230
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-636-6644
Practice Address - Fax:503-635-3099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist