# DR. ROBERT I. GOODMAN JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1053456657
- **Gender:** Man
- **Credential:** D.M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6563 | KY | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 07/08/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 263217 | TRIGON BCBS | KY |
| 01 | — | 6563 | LICENSE | KY |
| 01 | — | 802932 | UNITED CONCORDIA | KY |
| 01 | — | E933 | BCBS FEDERAL | KY |