Provider Demographics
NPI:1710278478
Name:GOODWIN, ADAM K (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:K
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:696 HIGHWAY 71 W STE 4D
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-5151
Mailing Address - Country:US
Mailing Address - Phone:512-321-5437
Mailing Address - Fax:888-317-1936
Practice Address - Street 1:696 HIGHWAY 71 W STE 4D
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5151
Practice Address - Country:US
Practice Address - Phone:512-321-5437
Practice Address - Fax:888-317-1936
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX287711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry