MEDICARE: DR. BEVERLY 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	1223G0001X	General Practice Dentistry	2901013967	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720041155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY GOODMAN DDS

Provider Business Mailing Address
First Line	:	1701 BALDWIN AVE
Second Line	:	SUITE 200
City	:	PONTIAC
State	:	MI
Zip	:	48340-3412
Country	:	US
Telephone Number	:	248-338-7333
Fax Number	:	248-338-6793

Provider Business Practice Location Address
First Line	:	1701 BALDWIN AVE
Second Line	:	SUITE 200
City	:	PONTIAC
State	:	MI
Zip	:	48340-3412
Country	:	US
Telephone Number	:	248-338-7333
Fax Number	:	248-338-6793

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. BEVERLY GOODMAN DDS” Practice Location

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