MEDICARE: DR. MEREDITH KRISTIN GOODRICH 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	122300000X	Dentist	DN16117	FL

General Provider Information

NPI Number	:	1902894652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEREDITH KRISTIN GOODRICH D.M.D.

Provider Business Mailing Address
First Line	:	PSC 47 BOX 67
Second Line	:
City	:	APO
State	:	AE
Zip	:	09470
Country	:	US
Telephone Number	:	011441480812826
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 SW MAIN BLVD
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-7050
Country	:	US
Telephone Number	:	386-752-2480
Fax Number	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	02/05/2009

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