Healthcare Provider Details

I. General information

NPI: 1598973406
Provider Name (Legal Business Name): LAWRENCE E. GOODMAN, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
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: 781-784-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAWRENCE GOODMAN
Title or Position: PRESIDENT
Credential: DMD
Phone: 781-784-3330