Provider Demographics
NPI:1316167471
Name:GOODMAN, IRWIN ARNOLD (DDS)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:ARNOLD
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23941 JOHN R.
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030
Mailing Address - Country:US
Mailing Address - Phone:248-547-2055
Mailing Address - Fax:248-547-0054
Practice Address - Street 1:23941 JOHN R.
Practice Address - Street 2:
Practice Address - City:HAZEL PARK
Practice Address - State:MI
Practice Address - Zip Code:48030
Practice Address - Country:US
Practice Address - Phone:248-547-2055
Practice Address - Fax:248-547-0054
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist