Individual
DR. JOHN GOODRICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MS
Contact information
Practice address
4919 DOUGLAS AVE, SUITE 12, DES MOINES, IA 50310
(515) 276-3664
Mailing address
4919 DOUGLAS AVE, SUITE 12, DES MOINES, IA 50310
(515) 276-3664
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
6461
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0162909
—
IA
01
—
162909
DELTA DENTAL
IA
Enumeration date
01/09/2007
Last updated
12/21/2017
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