Provider Demographics
NPI:1326188145
Name:GOYNE, WILLIAM BRANTLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRANTLEY
Last Name:GOYNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E 70TH ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5328
Mailing Address - Country:US
Mailing Address - Phone:318-789-3300
Mailing Address - Fax:
Practice Address - Street 1:2001 E 70TH ST
Practice Address - Street 2:SUITE 606
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5328
Practice Address - Country:US
Practice Address - Phone:318-789-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery