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General NPI Number Information
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NPI Number | 1528155413
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Entity Type | Individual
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Provider Name | HOWARD T GOODPASTER DMD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 ELEVENTH AVENUE SUITE D3
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City | SHCLIMAR
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State | FL
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Zip | 32579
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Country | US
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Telephone | 850-651-6700
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Fax | 850-609-0796
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Provider Business Mailing Address
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Address Line | 1 ELEVENTH AVENUE SUITE D3
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City | SHCLIMAR
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State | FL
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Zip | 32579
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Country | US
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Telephone | 850-651-6700
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Fax | 850-609-0796
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 11081
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License Number State | FL
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