MEDICARE: MR. JOSEPH M GOODMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	47521	CA

General Provider Information

NPI Number	:	1366427247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH M GOODMAN DDS

Provider Business Mailing Address
First Line	:	241 1/2 S BEVERLY DR
Second Line	:	2ND FLOOR
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3807
Country	:	US
Telephone Number	:	310-860-9311
Fax Number	:	310-860-9313

Provider Business Practice Location Address
First Line	:	241 1/2 S BEVERLY DR
Second Line	:	2ND FLOOR
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3807
Country	:	US
Telephone Number	:	310-860-9311
Fax Number	:	310-860-9313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/08/2007

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