Provider Demographics
NPI:1679130983
Name:GOODWINE, CLIFFORD KIRBY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:KIRBY
Last Name:GOODWINE
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 1:11 CANARY LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1645
Mailing Address - Country:US
Mailing Address - Phone:270-304-6547
Mailing Address - Fax:
Practice Address - Street 1:11 CANARY LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1645
Practice Address - Country:US
Practice Address - Phone:270-304-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0330251223P0221X
KY390200000X
KY11701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program