Provider Demographics
NPI:1720711963
Name:GOODPASTER, JAMELYN (DDS)
Entity Type:Individual
Prefix:
First Name:JAMELYN
Middle Name:
Last Name:GOODPASTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 STIRLING CIR UNIT 105
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7059
Mailing Address - Country:US
Mailing Address - Phone:317-847-9782
Mailing Address - Fax:
Practice Address - Street 1:5823 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2713
Practice Address - Country:US
Practice Address - Phone:804-833-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN269351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice