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General NPI Number Information
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NPI Number | 1174648505
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Entity Type | Organization
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Legal Business Name | GOODWIN G. THOMAS, JR., D.M.D., P.A.
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1033 BAYSHORE DR
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City | ROCK HILL
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State | SC
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Zip | 29732-1569
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Country | US
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Telephone | 803-324-5396
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Fax | 803-325-1415
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Provider Business Mailing Address
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Address Line | PO BOX 4456
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City | ROCK HILL
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State | SC
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Zip | 29732-6456
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Country | US
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Telephone | 803-324-5396
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Fax | 803-325-1415
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Authorized Official
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Title or Position | DOCTOR OWNER
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Name | DR. GOODWIN G THOMAS JR.
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Credential | D.M.D.
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Telephone | 803-324-5396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4206
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2215
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License Number State | SC
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