Individual
DR. MARK WESLEY GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
801 E TAMARACK RD, ALTUS, OK 73521-1231
(580) 482-5424
(580) 482-5429
Mailing address
801 E TAMARACK RD, ALTUS, OK 73521-1231
(580) 482-5424
(580) 482-5429
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4974
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
794911
UNITED CONCORDIA #
OK
Enumeration date
07/31/2006
Last updated
03/07/2023
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