Individual
DR. LEONARD J GOODGAME JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
207 WEST COMMERCE, ABERDEEN, MS 39730
(662) 369-2811
(662) 369-9810
Mailing address
PO BOX 132, ABERDEEN, MS 39730
(662) 369-2811
(662) 369-9810
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1014-61
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
061000
—
MS
Enumeration date
11/22/2006
Last updated
10/08/2008
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