MEDICARE: DR. JOHN T 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	1223P0700X	Prosthodontics	8669	TX

General Provider Information

NPI Number	:	1437153780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN T GOODMAN DDS

Provider Business Mailing Address
First Line	:	1808 WELLINGTON CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-6434
Country	:	US
Telephone Number	:	817-265-1051
Fax Number	:	817-275-6515

Provider Business Practice Location Address
First Line	:	1022 W MITCHELL ST
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2543
Country	:	US
Telephone Number	:	817-265-1051
Fax Number	:	817-275-8651

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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