Provider Demographics
NPI:1689881815
Name:GOODMAN, RICHARD B
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33139
Mailing Address - Country:US
Mailing Address - Phone:305-531-0063
Mailing Address - Fax:305-532-2983
Practice Address - Street 1:830 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BCH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-531-0063
Practice Address - Fax:305-532-2983
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist