Provider Demographics
NPI:1730529967
Name:GOODMAN-TABARI, ASHLEE P (DMD)
Entity type:Individual
Prefix:DR
First Name:ASHLEE
Middle Name:P
Last Name:GOODMAN-TABARI
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 1:10220 STAPLES MILL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3064
Mailing Address - Country:US
Mailing Address - Phone:804-767-2507
Mailing Address - Fax:804-767-2571
Practice Address - Street 1:10220 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3064
Practice Address - Country:US
Practice Address - Phone:804-767-2507
Practice Address - Fax:804-767-2571
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01014146701223G0001X
MD161761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN20518OtherMEDICAL LICENSE
MD119591300Medicaid
MD211877Medicare Oscar/Certification
MDS118Medicare PIN