Individual
DR. JOHN EARL GOODRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
450 W 6TH S, BOX 660, MOUNTAIN HOME, ID 83647-3483
(208) 587-3314
(208) 587-3921
Mailing address
PO BOX 660, MOUNTAIN HOME, ID 83647-0660
(208) 587-1111
(208) 587-3921
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D2090
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026928
—
ID
Enumeration date
08/10/2006
Last updated
12/23/2015
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