Provider Demographics
NPI:1659520955
Name:GOODIN, KERRY S (DDS)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:S
Last Name:GOODIN
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:PO BOX 70
Mailing Address - Street 2:60 W MAIN ST
Mailing Address - City:AUSTIN
Mailing Address - State:IN
Mailing Address - Zip Code:47102-0070
Mailing Address - Country:US
Mailing Address - Phone:812-794-2255
Mailing Address - Fax:
Practice Address - Street 1:60 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:IN
Practice Address - Zip Code:47102-1360
Practice Address - Country:US
Practice Address - Phone:812-794-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008972A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist