Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DN23123 | FL |
N | 1223P0300X | Periodontist | 035239 | NY |
Y | 1223P0300X | Periodontist | DN23123 | FL |
NPI | 1053574087 |
---|---|
Provider Name | Dr. Wendy Goodman |
First Address | The Villages, FL 32162-6038 |
Second Address | Leesberg, FL 34748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 16/01/2019 |