Brock Aaron Goodman, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

6023 Issued in NV

Practice address

702 C St
San Diego, CA 92101-5308

Phone

(408) 621-5779

NPI assigned

Aug 18, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380153600000",
    "number": "1821303538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3722 LAS VEGAS BLVD S",
            "address_2": "2104E",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891584301",
            "telephone_number": "408-621-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 C ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921015308",
            "telephone_number": "408-621-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "BROCK",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-18",
        "last_updated": "2013-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "59901",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NV",
            "license": "6023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glenn Putnam Goodlove, LCSW
• Gale Kirk Goodlow II, M.D.
• Stacey A Goodman Eaton, LCSW
• Skye Goodman-Janow
• Ashley Allen Goodman, DDS
• Eric Todd Goodman, M.D.
• Ira Lee Goodman, MD
• Jeffrey M. Goodman, MFT
• Jessica Goodman
• Krisztina Bodog Goodman, PSYD

• Orthodontics and Dentofacial Orthopedics Dentistry in San Diego, CA
• Providers in San Diego, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.