Wendy Goodman, DDS
Individual provider Active NPI Periodontics · Leesberg, FL
NPI 1053574087 · NPPES record last updated Jan 16, 2019
Key facts
- NPI
- 1053574087
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- DN23123 (FL)
- Practice address
- 949 N 14TH St
Leesberg, FL 34748 - Phone
- (352) 460-0164
- Fax
- (352) 559-3962
- NPI assigned
- Jul 9, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181115001018 | FL | Order and Referring Only - Dentist |
4284988957 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN23123 | FL | MD | Periodontist |
| 035239 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coast Dental P.a. | Dentist | Past | Accepting new patients |
| Coast Dental P.a. | Dentist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN23123 | FL | |
| Periodontics | 1223P0300X | 035239 | NY | |
| Periodontics | 1223P0300X | DN23123 | FL | Yes |
Addresses
Primary practice location
949 N 14TH St
Leesberg, FL 34748
Mailing address
2756 Cutters Cor
The Villages, FL 32162-6038
Phone (352) 973-2007
Other practice location 1
870 N US Highway 27
Lady Lake, FL 32159
Phone (352) 282-4785
Other practice location 2
1590 E 19th St
Brooklyn, NY 11230-7204
Phone (718) 339-3297
Other practice location 3
2689 E Gulf To Lake Hwy
Inverness, FL 34453-3216
Phone (352) 637-1114
Other providers in Leesberg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.