Healthcare Provider Details

I. General information

NPI: 1932328036
Provider Name (Legal Business Name): ROBERT F. GOOD II D.M.D, M.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 WASHINGTON ST
WASHINGTON PA
15301-4605
US

IV. Provider business mailing address

111 WASHINGTON ST
WASHINGTON PA
15301-4605
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-1114
  • Fax: 724-223-0238
Mailing address:
  • Phone: 724-225-1114
  • Fax: 724-223-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS020744L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: