Provider Demographics
NPI:1063674356
Name:GOODWIN, AMY (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9521 BOTTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0501
Mailing Address - Country:US
Mailing Address - Phone:702-767-2461
Mailing Address - Fax:
Practice Address - Street 1:6910 S RAINBOW BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3274
Practice Address - Country:US
Practice Address - Phone:702-362-5437
Practice Address - Fax:702-631-5437
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV60211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry