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General NPI Number Information
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NPI Number | 1578638532
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Entity Type | Individual
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Provider Name | LEONARD J GOODGAME JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 207 WEST COMMERCE
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City | ABERDEEN
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State | MS
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Zip | 39730
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Country | US
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Telephone | 662-369-2811
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Fax | 662-369-9810
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Provider Business Mailing Address
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Address Line | PO BOX 132
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City | ABERDEEN
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State | MS
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Zip | 39730
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Country | US
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Telephone | 662-369-2811
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Fax | 662-369-9810
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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 | 1014-61
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License Number State | MS
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