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General NPI Number Information
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NPI Number | 1144421678
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Entity Type | Organization
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Legal Business Name | DR. ALVIN S. GOODMAN, P.A.
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3535 RANDOLPH RD. SUITE R-101
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City | CHARLOTTE
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State | NC
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Zip | 28211-1032
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Country | US
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Telephone | 704-366-3452
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Fax | 704-366-3065
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Provider Business Mailing Address
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Address Line | 3535 RANDOLPH RD SUITE R-101
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City | CHARLOTTE
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State | NC
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Zip | 28211-1032
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Country | US
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Telephone | 704-366-3452
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Fax | 704-366-3065
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALVIN S GOODMAN
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Credential | D.D.S.,M.SC.D.
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Telephone | 704-366-3452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 2833
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License Number State | NC
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