Provider Demographics
NPI:1912636457
Name:GOODSON, JAMES ARTHUR IV (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:GOODSON
Suffix:IV
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 1:656 BULTMAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2550
Mailing Address - Country:US
Mailing Address - Phone:803-778-2337
Mailing Address - Fax:
Practice Address - Street 1:656 BULTMAN DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2550
Practice Address - Country:US
Practice Address - Phone:803-778-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC102091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice