Provider Demographics
NPI:1144625807
Name:GOODMAN DENTAL CARE LLC
Entity type:Organization
Organization Name:GOODMAN DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-263-1919
Mailing Address - Street 1:2530 RIVA RD
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7413
Mailing Address - Country:US
Mailing Address - Phone:410-263-1919
Mailing Address - Fax:
Practice Address - Street 1:2530 RIVA RD
Practice Address - Street 2:SUITE # 201
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7413
Practice Address - Country:US
Practice Address - Phone:410-263-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD59061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty