Healthcare Provider Details

I. General information

NPI: 1730012600
Provider Name (Legal Business Name): RACHEL GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21050 N TATUM BLVD STE 200
PHOENIX AZ
85050-4262
US

IV. Provider business mailing address

1500 N MARKDALE UNIT 1
MESA AZ
85201-2445
US

V. Phone/Fax

Practice location:
  • Phone: 713-540-8369
  • Fax:
Mailing address:
  • Phone: 713-540-8369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012845
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: