Provider Demographics
NPI:1811006067
Name:ASHLEY A GOODMAN DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ASHLEY A GOODMAN DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-697-6677
Mailing Address - Street 1:8736 LAKE MURRAY BLVD
Mailing Address - Street 2:STE 108
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119
Mailing Address - Country:US
Mailing Address - Phone:619-697-6677
Mailing Address - Fax:619-697-6632
Practice Address - Street 1:8736 LAKE MURRAY BLVD
Practice Address - Street 2:STE 108
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119
Practice Address - Country:US
Practice Address - Phone:619-697-6677
Practice Address - Fax:619-697-6632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA206281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty