Healthcare Provider Details

I. General information

NPI: 1083811277
Provider Name (Legal Business Name): BRIAN JOSEPH GOODMAN D,D,S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 E. PECOS RD. SUITE 101
GILBERT AZ
85295
US

IV. Provider business mailing address

4727 E. PECOS RD SUITE 101
GILBERT AZ
85295
US

V. Phone/Fax

Practice location:
  • Phone: 480-807-4000
  • Fax: 480-807-4002
Mailing address:
  • Phone: 480-807-4000
  • Fax: 480-807-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD7280
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: