Provider Demographics
NPI:1598797540
Name:GOODMAN, ROBYN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2301
Mailing Address - Country:US
Mailing Address - Phone:775-971-3971
Mailing Address - Fax:775-473-4268
Practice Address - Street 1:5990 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-2301
Practice Address - Country:US
Practice Address - Phone:775-971-3971
Practice Address - Fax:775-473-4268
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53791122300000X
NV4858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist