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General NPI Number Information
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NPI Number | 1619564069
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Entity Type | Organization
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Legal Business Name | KATHERINE L. GOODWIN, D.D.S., LLC
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 4106 6TH AVE
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City | KEARNEY
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State | NE
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Zip | 68845-3395
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Country | US
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Telephone | 308-237-3479
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Fax | 308-236-9642
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Provider Business Mailing Address
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Address Line | PO BOX 3198
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City | KEARNEY
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State | NE
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Zip | 68848-3198
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Country | US
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Telephone | 308-237-3479
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Fax | 308-236-9642
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE GOODWIN
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Credential | DDS
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Telephone | 308-237-3479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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