Provider Demographics
NPI:1639295652
Name:PATIENT DENTISTRY,P.C.
Entity Type:Organization
Organization Name:PATIENT DENTISTRY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-483-9621
Mailing Address - Street 1:113 SOUTH KALAMAZOO ST.
Mailing Address - Street 2:P.O. BOX 695
Mailing Address - City:WHITE PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:49099
Mailing Address - Country:US
Mailing Address - Phone:269-483-9621
Mailing Address - Fax:269-483-2569
Practice Address - Street 1:113 SOUTH KALAMAZOO ST.
Practice Address - Street 2:
Practice Address - City:WHITE PIGEON
Practice Address - State:MI
Practice Address - Zip Code:49099
Practice Address - Country:US
Practice Address - Phone:269-483-9621
Practice Address - Fax:269-483-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134259047OtherNPI TYPE 1
MI2901016419OtherDENTIST LICENSE
MI1134259047OtherNPI TYPE 1