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General NPI Number Information
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NPI Number | 1942650817
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Entity Type | Individual
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Provider Name | MICHELLE GOODMAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 41B STATE ST
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City | LYNN
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State | MA
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Zip | 01901-1504
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Country | US
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Telephone | 781-292-4319
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Fax |
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Provider Business Mailing Address
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Address Line | 145 COMMERCIAL ST. UNIT 534
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City | BOSTON
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State | MA
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Zip | 02109
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Country | US
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Telephone |
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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 | DN 21912
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License Number State | FL
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