Provider Demographics
NPI:1902828817
Name:LYNN M. GODWIN, D.D.S., P.A.
Entity Type:Organization
Organization Name:LYNN M. GODWIN, D.D.S., P.A.
Other - Org Name:GODWIN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-854-4344
Mailing Address - Street 1:301 KEISLER DR STE B
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7018
Mailing Address - Country:US
Mailing Address - Phone:919-854-4344
Mailing Address - Fax:919-854-4340
Practice Address - Street 1:301 KEISLER DR STE B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7018
Practice Address - Country:US
Practice Address - Phone:919-854-4344
Practice Address - Fax:919-854-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty