MEDICARE: RICHARD B GOODMAN

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	8871	FL

General Provider Information

NPI Number	:	1689881815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD B GOODMAN

Provider Business Mailing Address
First Line	:	830 WASHINGTON AVE
Second Line	:
City	:	MIAMI BCH
State	:	FL
Zip	:	33139
Country	:	US
Telephone Number	:	305-531-0063
Fax Number	:	305-532-2983

Provider Business Practice Location Address
First Line	:	830 WASHINGTON AVE
Second Line	:
City	:	MIAMI BCH
State	:	FL
Zip	:	33139
Country	:	US
Telephone Number	:	305-531-0063
Fax Number	:	305-532-2983

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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Directions to “ RICHARD B GOODMAN ” Practice Location

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