Provider Demographics
NPI:1053436105
Name:GOODKIN, HOWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:GOODKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E MILL RD
Mailing Address - Street 2:SUITE 2-2034
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-6215
Mailing Address - Country:US
Mailing Address - Phone:908-876-5225
Mailing Address - Fax:908-876-1062
Practice Address - Street 1:59 E MILL RD
Practice Address - Street 2:SUITE 2-2034
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853-6215
Practice Address - Country:US
Practice Address - Phone:908-876-5225
Practice Address - Fax:908-876-1062
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ153611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice