Provider Demographics
NPI:1710026083
Name:GOODIN, LEONARD WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:WAYNE
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 1:3850 SOUTH NATIONAL AVENUE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-869-6487
Mailing Address - Fax:417-269-7549
Practice Address - Street 1:3850 SOUTH NATIONAL AVENUE
Practice Address - Street 2:SUITE 720
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-869-6487
Practice Address - Fax:417-269-7549
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO011444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist