Provider Demographics
NPI:1942398326
Name:POWELL, STEPHEN GOODWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GOODWIN
Last Name:POWELL
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 1:304 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:MO
Mailing Address - Zip Code:65781-9333
Mailing Address - Country:US
Mailing Address - Phone:417-742-2555
Mailing Address - Fax:417-742-4400
Practice Address - Street 1:304 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781-9333
Practice Address - Country:US
Practice Address - Phone:417-742-2555
Practice Address - Fax:417-742-4400
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0117061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice