Provider Demographics
NPI:1770517872
Name:GOODMAN, DAVID A (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2239
Mailing Address - Country:US
Mailing Address - Phone:508-478-3800
Mailing Address - Fax:508-634-9950
Practice Address - Street 1:192 WEST ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2239
Practice Address - Country:US
Practice Address - Phone:508-478-3800
Practice Address - Fax:508-634-9950
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice