Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | FLDN0005382 | FL |
NPI | 1003824905 |
---|---|
Provider Name | Dr. Harold Goodman |
First Address | Homestead, FL 33030 |
Second Address | Homestead, FL 33030-5024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 24/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
680697096 | (05) | FL |