Provider Demographics
NPI:1174648505
Name:GOODWIN G. THOMAS, JR., D.M.D., P.A.
Entity Type:Organization
Organization Name:GOODWIN G. THOMAS, JR., D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOODWIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-324-5396
Mailing Address - Street 1:PO BOX 4456
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6456
Mailing Address - Country:US
Mailing Address - Phone:803-324-5396
Mailing Address - Fax:803-325-1415
Practice Address - Street 1:1033 BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1569
Practice Address - Country:US
Practice Address - Phone:803-324-5396
Practice Address - Fax:803-325-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22151223X0400X
SC42061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty