Provider Demographics
NPI:1154417715
Name:GOODMAN, ROBERT ALAN (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 N. CHARLES ST.
Mailing Address - Street 2:STE. 3
Mailing Address - City:BALTO.
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:410-372-0766
Mailing Address - Fax:
Practice Address - Street 1:6301 N. CHARLES ST.
Practice Address - Street 2:STE. 3
Practice Address - City:BALTO.
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:410-372-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD60221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice