Provider Demographics
NPI:1396808028
Name:GOODMAN, DAVID BARNETT (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BARNETT
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 1:3755 76TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6507
Mailing Address - Country:US
Mailing Address - Phone:718-429-6116
Mailing Address - Fax:
Practice Address - Street 1:3755 76TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6507
Practice Address - Country:US
Practice Address - Phone:718-429-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0264221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026422OtherLICENSE NUMBER
NY00620939Medicaid