Provider Demographics
NPI:1598887549
Name:GOODOWITZ, WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:GOODOWITZ
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 1:5400 BLACKHAWK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2807
Mailing Address - Country:US
Mailing Address - Phone:214-616-1745
Mailing Address - Fax:
Practice Address - Street 1:1200 COIT RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4750
Practice Address - Country:US
Practice Address - Phone:972-596-3702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice