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General NPI Number Information
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NPI Number | 1497115273
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Entity Type | Organization
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Legal Business Name | MATTHEW PHILLIP GOODRICH
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 125 MURRAY HILL RD STE G
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-6354
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Country | US
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Telephone | 910-693-1977
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Fax | 910-693-1877
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Provider Business Mailing Address
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Address Line | 125 MURRAY HILL RD STE G
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-6354
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Country | US
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Telephone | 910-693-1977
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Fax | 910-693-1877
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MATTHEW PHILLIP GOODRICH
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Credential | D.D.S.
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Telephone | 910-693-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10153
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License Number State | NC
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