Individual
DR. MARK GOODENOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
256C MASON AVE, STATEN ISLAND, NY 10305-3408
(718) 226-1251
Mailing address
256 MASON AVE # C, STATEN ISLAND, NY 10305-3408
(718) 226-1251
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
063143
NY
208D00000X
General Practice Physician
311698
NY
Other
Enumeration date
05/22/2017
Last updated
06/26/2024
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