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General NPI Number Information
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NPI Number | 1841219276
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Entity Type | Individual
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Provider Name | CLIFFORD T GOODWIN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 06/09/2016
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Provider Practice Location Address
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Address Line | 12515 WARWICK BLVD STE 203
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2964
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Country | US
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Telephone | 757-930-3744
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Fax | 757-930-2726
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Provider Business Mailing Address
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Address Line | 12610 PATRICK HENRY DR STE G
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-9538
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Country | US
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Telephone | 757-930-3355
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Fax | 757-930-2726
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6165
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License Number State | VA
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