Provider Demographics
NPI:1073918165
Name:CLIFFORD T. GOODWIN, DDS
Entity Type:Organization
Organization Name:CLIFFORD T. GOODWIN, DDS
Other - Org Name:A DIVISION OF ATLANTIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-930-3744
Mailing Address - Street 1:12610 PATRICK HENRY DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9538
Mailing Address - Country:US
Mailing Address - Phone:757-930-3744
Mailing Address - Fax:757-930-2726
Practice Address - Street 1:12610 PATRICK HENRY DR
Practice Address - Street 2:SUITE G
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9538
Practice Address - Country:US
Practice Address - Phone:757-930-3744
Practice Address - Fax:757-930-2726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401006165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty