Provider Demographics
NPI:1831276492
Name:GOODMAN, ROBERT WILLIAM (DDS MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8050 GREENLAWN CT
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382
Mailing Address - Country:US
Mailing Address - Phone:248-465-7500
Mailing Address - Fax:248-465-7501
Practice Address - Street 1:42430 WEST TWELVE MILE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3028
Practice Address - Country:US
Practice Address - Phone:248-465-7500
Practice Address - Fax:248-465-7501
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-07893122300000X
MI29010176231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist