Individual
DR. DANIEL TIM GOODMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
305 E BROADWAY ST, BOLIVAR, MO 65613-1625
(417) 326-4113
(417) 326-4115
Mailing address
305 E BROADWAY ST, BOLIVAR, MO 65613-1625
(417) 326-4113
(417) 326-4115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2005015020
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750791
UNITED CONCORDIA
MO
Enumeration date
12/11/2006
Last updated
07/08/2007
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