MEDICARE: DR. JAMES CLINTON GOODWIN DMD

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
1	122300000X	Dentist	AZ03540	AZ

General Provider Information

NPI Number	:	1366495087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES CLINTON GOODWIN DMD

Provider Business Mailing Address
First Line	:	10134 N ORACLE RD STE 170
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85704-7612
Country	:	US
Telephone Number	:	520-848-3889
Fax Number	:	520-989-3134

Provider Business Practice Location Address
First Line	:	10134 N ORACLE RD STE 170
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85704-7612
Country	:	US
Telephone Number	:	520-848-3889
Fax Number	:	520-989-3134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	11/02/2021

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