Provider Demographics
NPI:1194810556
Name:GOODMAN, ALAN T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:T
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:999 PEACHTREE ST., NE
Mailing Address - Street 2:SUITE 705
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-885-1441
Mailing Address - Fax:404-885-1410
Practice Address - Street 1:999 PEACHTREE ST., NE
Practice Address - Street 2:SUITE 705
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-885-1441
Practice Address - Fax:404-885-1410
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA90461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics