Healthcare Provider Details

I. General information

NPI: 1245254234
Provider Name (Legal Business Name): DAVID C GOODWIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 E LAYTON ROAD
FREELAND WA
98249
US

IV. Provider business mailing address

PO BOX 40
FREELAND WA
98249-0040
US

V. Phone/Fax

Practice location:
  • Phone: 360-331-6100
  • Fax:
Mailing address:
  • Phone: 360-331-6100
  • Fax: 360-331-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: