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General NPI Number Information
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NPI Number | 1386654317
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Entity Type | Organization
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Legal Business Name | WAYNE K. GOODNER, D.D.S., P.C.
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1751 W ORANGE GROVE RD SUITE 101
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City | TUCSON
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State | AZ
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Zip | 85704-1194
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Country | US
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Telephone | 520-742-4227
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Fax | 520-742-4892
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Provider Business Mailing Address
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Address Line | 1751 W ORANGE GROVE RD SUITE 101
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City | TUCSON
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State | AZ
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Zip | 85704-1194
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Country | US
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Telephone | 520-742-4227
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Fax | 520-742-4892
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KAREN GAIL GOODNER
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Credential |
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Telephone | 520-742-4227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 07 549511 Q
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License Number State | AZ
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