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General NPI Number Information
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NPI Number | 1760564140
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Entity Type | Organization
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Legal Business Name | KERRY S. GOODIN, D.D.S., P.C.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 60 W MAIN ST PO BXO 70
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City | AUSTIN
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State | IN
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Zip | 47102-0070
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Country | US
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Telephone | 812-794-2255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70 60 W MAIN ST
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City | AUSTIN
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State | IN
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Zip | 47102-0070
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Country | US
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Telephone | 812-794-2255
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KERRY S GOODIN
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Credential | D.D.S.
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Telephone | 812-794-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12008972A
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License Number State | IN
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