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General NPI Number Information
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NPI Number | 1225250905
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Entity Type | Individual
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Provider Name | JAMES B GOODMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 605 MARINE AVE
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City | KENAI
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State | AK
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Zip | 99611-6928
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Country | US
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Telephone | 907-283-4875
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Fax |
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Provider Business Mailing Address
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Address Line | 27498 NORTHRIDGE RD., PO BOX 726
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City | DAVENPORT
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State | WA
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Zip | 99122
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Country | US
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Telephone | 509-721-0904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 472
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | LL537764
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License Number State | MI
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