Healthcare Provider Details

I. General information

NPI: 1487644472
Provider Name (Legal Business Name): LAWRENCE GOODMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N MAIN ST
SHARON MA
02067-1172
US

IV. Provider business mailing address

PO BOX 67
SHARON MA
02067-0067
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-3330
  • Fax: 781-784-3363
Mailing address:
  • Phone: 781-784-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17672
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: