Provider Demographics
NPI:1619564069
Name:KATHERINE L. GOODWIN, D.D.S., LLC
Entity Type:Organization
Organization Name:KATHERINE L. GOODWIN, D.D.S., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-237-3479
Mailing Address - Street 1:PO BOX 3198
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-3198
Mailing Address - Country:US
Mailing Address - Phone:308-237-3479
Mailing Address - Fax:308-236-9642
Practice Address - Street 1:4106 6TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3395
Practice Address - Country:US
Practice Address - Phone:308-237-3479
Practice Address - Fax:308-236-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental