Healthcare Provider Details

I. General information

NPI: 1164160966
Provider Name (Legal Business Name): DAVID GOODMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N MAIN ST STE 4
SHARON MA
02067-1172
US

IV. Provider business mailing address

450 N MAIN ST STE 4
SHARON MA
02067-1172
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-3330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043602
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1859710
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: