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General NPI Number Information
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NPI Number | 1609516673
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Entity Type | Individual
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Provider Name | CHARLETON YVES-MARIE B GOODMAN
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Gender | Female
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 727 25TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4601
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Country | US
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Telephone | 757-316-5210
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Fax |
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD STE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1318
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Country | US
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Telephone | 757-316-5800
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401418322
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License Number State | VA
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