Provider Demographics
NPI:1902894652
Name:GOODRICH, MEREDITH KRISTIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:KRISTIN
Last Name:GOODRICH
Suffix:
Gender:F
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:PSC 47 BOX 67
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09470
Mailing Address - Country:US
Mailing Address - Phone:01144148-081-2826
Mailing Address - Fax:
Practice Address - Street 1:255 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7050
Practice Address - Country:US
Practice Address - Phone:386-752-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16117122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist