Healthcare Provider Details

I. General information

NPI: 1194810556
Provider Name (Legal Business Name): ALAN T. GOODMAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 PEACHTREE ST., NE SUITE 705
ATLANTA GA
30309
US

IV. Provider business mailing address

999 PEACHTREE ST., NE SUITE 705
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 404-885-1441
  • Fax: 404-885-1410
Mailing address:
  • Phone: 404-885-1441
  • Fax: 404-885-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: