Active NPI
Robert Good, DDS
- Dentist
- Albuquerque, NM
National Provider Identifier
1164438818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DD2023
- Practice address
- 9169 Coors Blvd NW
Albuquerque, NM 87120-3101 - Phone
- (505) 346-2306
- Fax
- (505) 346-2311
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD2023 | NM | Primary |
| Dentist | 122300000X | 7096 | CO | |
| Dentist | 122300000X | 12081 | MD |
Addresses
Primary practice location
9169 Coors Blvd NW
Albuquerque, NM 87120-3101
Mailing address
PO Box 67830
Albuquerque, NM 87193-7830
Phone (505) 346-2306
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B4827 | Medicaid | NM | |
| 631558 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7096 | CO | MD | Chiropractor |
| DD2023 | NM | MD | Dentist |
| 12081 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Albuquerque I.H.S. Dental Clinic | Past | Accepting new patients |
Interoperability endpoints
- robert.good.p1@direct.frederikstedhealthvi.nextgenshare.com
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Albuquerque, NM
- NPI 1497849186
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164438818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 67830",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871937830",
"telephone_number": "505-346-2306",
"fax_number": "505-346-2311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9169 COORS BLVD NW",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871203101",
"telephone_number": "505-346-2306",
"fax_number": "505-346-2311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOD",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD2023",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "7096",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "12081",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "B4827",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "631558",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.