Provider Demographics
NPI:1003824905
Name:GOODMAN, HAROLD (DDS MBA PA)
Entity type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DDS MBA PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NE 8TH ST
Mailing Address - Street 2:HAROLD GOODMAN DDS PA
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:305-245-0304
Mailing Address - Fax:305-245-0306
Practice Address - Street 1:833 N HOMESTEAD BLVD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5024
Practice Address - Country:US
Practice Address - Phone:305-246-3389
Practice Address - Fax:305-246-1695
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLDN0005382122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680697096Medicaid