Provider Demographics
NPI:1528155413
Name:GOODPASTER, HOWARD T (DMD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:T
Last Name:GOODPASTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELEVENTH AVENUE
Mailing Address - Street 2:SUITE D3
Mailing Address - City:SHCLIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579
Mailing Address - Country:US
Mailing Address - Phone:850-651-6700
Mailing Address - Fax:850-609-0796
Practice Address - Street 1:1 ELEVENTH AVENUE
Practice Address - Street 2:SUITE D3
Practice Address - City:SHCLIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579
Practice Address - Country:US
Practice Address - Phone:850-651-6700
Practice Address - Fax:850-609-0796
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11801OtherLICENSE NUMBER
FL67946OtherBLUE CROSS BLUE SHIELD FL
FL1436581OtherUNITED CONCORIDA INS CO