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General NPI Number Information
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NPI Number | 1720711963
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Entity Type | Individual
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Provider Name | JAMELYN GOODPASTER DDS
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Gender | Female
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 5823 MAIN ST
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-2713
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Country | US
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Telephone | 804-833-4739
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 STIRLING CIR UNIT 105
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City | DUNEDIN
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State | FL
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Zip | 34698-7059
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Country | US
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Telephone | 317-847-9782
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN26935
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License Number State | FL
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