MEDICARE: DR. JASON HUSBAND GOODCHILD D.M.D.

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	1223G0001X	General Practice Dentistry	DS030596L	PA

General Provider Information

NPI Number	:	1518027804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON HUSBAND GOODCHILD D.M.D.

Provider Business Mailing Address
First Line	:	1231 PILGRIM LN
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-1851
Country	:	US
Telephone Number	:	610-296-3873
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 W BOOT RD
Second Line	:
City	:	WEST CHESTER
State	:	PA
Zip	:	19380-1109
Country	:	US
Telephone Number	:	610-918-1710
Fax Number	:

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

Provider Enumeration Date	:	12/09/2006
Last Update Date	:	07/08/2007

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