Provider Demographics
NPI:1760564140
Name:KERRY S. GOODIN, D.D.S., P.C.
Entity Type:Organization
Organization Name:KERRY S. GOODIN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOODIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-794-2255
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:PO BXO 70
Practice Address - City:AUSTIN
Practice Address - State:IN
Practice Address - Zip Code:47102-0070
Practice Address - Country:US
Practice Address - Phone:812-794-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008972A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty