Provider Demographics
NPI:1609084292
Name:GOODE, MARTIN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:RICHARD
Last Name:GOODE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7459 MIDDLEBELT RD
Mailing Address - Street 2:#4
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4184
Mailing Address - Country:US
Mailing Address - Phone:248-626-0600
Mailing Address - Fax:248-626-0603
Practice Address - Street 1:7459 MIDDLEBELT RD
Practice Address - Street 2:#4
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4184
Practice Address - Country:US
Practice Address - Phone:248-626-0600
Practice Address - Fax:248-626-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI94121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics