Provider Demographics
NPI:1609107028
Name:ALFRED S. GOODMAN, DDS, MSD, INC
Entity Type:Organization
Organization Name:ALFRED S. GOODMAN, DDS, MSD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-668-6162
Mailing Address - Street 1:5959 WEST LOOP SOUTH #610
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401
Mailing Address - Country:US
Mailing Address - Phone:713-668-6162
Mailing Address - Fax:773-668-6155
Practice Address - Street 1:5959 WEST LOOP SOUTH #610
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-668-6162
Practice Address - Fax:773-668-6155
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALFRED S. GOODMAN, DDS, MSD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX072521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX13509Medicare UPIN