Provider Demographics
NPI:1578688966
Name:THOMAS, GOODWIN G JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:GOODWIN
Middle Name:G
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1474 HWY 55 E SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710
Mailing Address - Country:US
Mailing Address - Phone:803-653-6979
Mailing Address - Fax:803-325-1415
Practice Address - Street 1:1474 HWY 55 E SUITE 100
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710
Practice Address - Country:US
Practice Address - Phone:803-653-6979
Practice Address - Fax:803-325-1415
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics