Provider Demographics
NPI:1942540273
Name:GOODMAN, MADELEINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CONNECTICUT AVE NW
Mailing Address - Street 2:#212
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-4556
Mailing Address - Country:US
Mailing Address - Phone:202-297-2369
Mailing Address - Fax:
Practice Address - Street 1:3701 CONNECTICUT AVE NW
Practice Address - Street 2:#212
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4556
Practice Address - Country:US
Practice Address - Phone:202-297-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD149091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics