Provider Demographics
NPI:1790449148
Name:KRISTIN L. GOODWIN, D.D.S., P.A.
Entity Type:Organization
Organization Name:KRISTIN L. GOODWIN, D.D.S., P.A.
Other - Org Name:KRISTIN L. GOODWIN DDS, PA AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:1897 PECOS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3231
Mailing Address - Country:US
Mailing Address - Phone:325-655-9133
Mailing Address - Fax:
Practice Address - Street 1:1897 PECOS ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3231
Practice Address - Country:US
Practice Address - Phone:325-655-9133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty