MEDICARE: MELBA JOYCE GOODWIN RDH

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	124Q00000X	Dental Hygienist	DH3820	TN

General Provider Information

NPI Number	:	1962576298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELBA JOYCE GOODWIN RDH

Provider Business Mailing Address
First Line	:	126 TARA RD
Second Line	:
City	:	UNIONVILLE
State	:	TN
Zip	:	37180-5039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5073 COLUMBIA PIKE
Second Line	:	SUITE 240
City	:	SPRING HILL
State	:	TN
Zip	:	37174-8607
Country	:	US
Telephone Number	:	615-302-4200
Fax Number	:	615-302-4201

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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