Individual
DR. JUSTIN RYAN GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
13023 SE 84TH AVE STE A, CLACKAMAS, OR 97015-9798
(503) 353-9992
Mailing address
13023 SE 84TH AVE STE A, CLACKAMAS, OR 97015-9798
(503) 353-9992
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D9165
OR
Other
Enumeration date
09/10/2008
Last updated
01/22/2010
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