Provider Demographics
NPI:1972642932
Name:GOODMAN, JOHN PATRICK A (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK A
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 1:2700 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 470
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3251
Mailing Address - Country:US
Mailing Address - Phone:816-842-5335
Mailing Address - Fax:816-842-2141
Practice Address - Street 1:2700 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 470
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3251
Practice Address - Country:US
Practice Address - Phone:816-842-5335
Practice Address - Fax:816-842-2141
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist