Provider Demographics
NPI:1922103563
Name:GOODMAN, MICHAEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 EAST 50TH STREET
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:212-533-3385
Mailing Address - Fax:212-832-3014
Practice Address - Street 1:245 EAST 55TH ST
Practice Address - Street 2:C/O ELK DENTAL ASSOCIATES
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-593-1212
Practice Address - Fax:212-832-3014
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0301691223G0001X
NY301691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice