MEDICARE: DR. LINDA ANN GOODMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	015248	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043426273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA ANN GOODMAN D.D.S.

Provider Business Mailing Address
First Line	:	3679 WOODVIEW AVE
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-2670
Country	:	US
Telephone Number	:	248-360-9372
Fax Number	:

Provider Business Practice Location Address
First Line	:	8010 N MIDDLEBELT RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-1808
Country	:	US
Telephone Number	:	734-421-2675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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