MEDICARE: RACHEL 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	D012845	AZ

General Provider Information

NPI Number	:	1730012600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL GOODMAN

Provider Business Mailing Address
First Line	:	1500 N MARKDALE UNIT 1
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-2445
Country	:	US
Telephone Number	:	713-540-8369
Fax Number	:

Provider Business Practice Location Address
First Line	:	21050 N TATUM BLVD STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4262
Country	:	US
Telephone Number	:	713-540-8369
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “ RACHEL GOODMAN ” Practice Location

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