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NPI Code Detail

MEDICARE: DR. BROOKE D GOODWIN DDS

MEDICARE: DR. BROOKE D GOODWIN DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry0401414699VA

General Provider Information

NPI Number : 1124307202
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BROOKE D GOODWIN DDS
Provider Business Mailing Address
First Line : 101 HEARTLAND CT
Second Line :
City : DAYTON
State : VA
Zip : 22821-9000
Country : US
Telephone Number : 540-879-9211
Fax Number : 540-879-9007
Provider Business Practice Location Address
First Line : 101 HEARTLAND CT
Second Line :
City : DAYTON
State : VA
Zip : 22821-9000
Country : US
Telephone Number : 540-879-9211
Fax Number : 540-879-9007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2011
Last Update Date : 03/05/2015

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Directions to “ DR. BROOKE D GOODWIN DDS” Practice Location

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