MEDICARE: ALLAN L. GOINS JR. DDS, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12007859A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942680855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLAN L. GOINS JR. DDS, PSC

Provider Business Mailing Address
First Line	:	67 LONG ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-2313
Country	:	US
Telephone Number	:	812-346-5451
Fax Number	:	812-346-8456

Provider Business Practice Location Address
First Line	:	67 LONG ST
Second Line	:
City	:	NORTH VERNON
State	:	IN
Zip	:	47265-2313
Country	:	US
Telephone Number	:	812-346-5451
Fax Number	:	812-346-8456

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. ALLAN L GOINS JR.
Credential	:	DDS
Telephone Number	:	812-346-5451

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	06/05/2015

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