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General NPI Number Information
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NPI Number | 1497870398
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Entity Type | Individual
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Provider Name | RICHARD L GOODMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 391 QUADRANGLE DR SUITE S-5
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3442
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Country | US
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Telephone | 630-759-4400
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Fax | 630-759-9528
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Provider Business Mailing Address
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Address Line | 11912 WINTERBERRY LN
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City | PLAINFIELD
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State | IL
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Zip | 60585-5683
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Country | US
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Telephone | 630-759-4400
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Fax | 630-759-9528
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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 | 19015125
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License Number State | IL
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