Provider Demographics
NPI:1366495087
Name:GOODWIN, JAMES CLINTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLINTON
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10134 N ORACLE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7612
Mailing Address - Country:US
Mailing Address - Phone:520-848-3889
Mailing Address - Fax:520-989-3134
Practice Address - Street 1:10134 N ORACLE RD STE 170
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85704-7612
Practice Address - Country:US
Practice Address - Phone:520-848-3889
Practice Address - Fax:520-989-3134
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ03540122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist