Organization
DANIEL T. GOODMAN DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL T GOODMAN DDS (OWNER/DENTIST)
(417) 326-4113
Entity
Organization
Contact information
Practice address
305 E BROADWAY ST, BOLIVAR, MO 65613-1625
(417) 326-4113
(417) 326-4115
Mailing address
305 E BROADWAY ST, BOLIVAR, MO 65613-1625
(417) 326-4113
(417) 326-4115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2005015020
MO
Other
Enumeration date
08/04/2008
Last updated
08/04/2008
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