Healthcare Provider Details

I. General information

NPI: 1326954025
Provider Name (Legal Business Name): GOODWIN DENTAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 APPLE ST
NORCO LA
70079-2216
US

IV. Provider business mailing address

2623 SAINT ANN ST
NEW ORLEANS LA
70119
US

V. Phone/Fax

Practice location:
  • Phone: 318-617-8693
  • Fax:
Mailing address:
  • Phone: 318-617-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH LANE GOODWIN
Title or Position: OWNER
Credential: DDS
Phone: 318-617-8693