Healthcare Provider Details

I. General information

NPI: 1023096047
Provider Name (Legal Business Name): RONALD SCOTT GOODMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28282 DEQUINDRE RD
WARREN MI
48092-5604
US

IV. Provider business mailing address

28478 DEQUINDRE RD
WARREN MI
48092-5605
US

V. Phone/Fax

Practice location:
  • Phone: 586-574-2620
  • Fax: 586-574-4560
Mailing address:
  • Phone: 586-574-2620
  • Fax: 586-574-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15034
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: