Individual
NANCY LEE GOODARE-ROSENTHAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
155 N HARBOR DR, APT 2409, CHICAGO, IL 60601-5007
(312) 996-7546
(312) 355-4173
Mailing address
155 N HARBOR DR, CHICAGO, IL 60601-7364
(719) 588-3146
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030532
IL
122300000X
Dentist
8414
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60501332
—
CO
01
—
840706945137
ROCKY MOUNTAIN HEALTH PLA
CO
01
—
94984018
NEW MEXICO MEDICAID
—
Enumeration date
10/13/2005
Last updated
10/19/2018
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