Provider Demographics
NPI:1942680855
Name:ALLAN L. GOINS JR. DDS, PSC
Entity Type:Organization
Organization Name:ALLAN L. GOINS JR. DDS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-346-5451
Mailing Address - Street 1:67 LONG ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-2313
Mailing Address - Country:US
Mailing Address - Phone:812-346-5451
Mailing Address - Fax:812-346-8456
Practice Address - Street 1:67 LONG ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-2313
Practice Address - Country:US
Practice Address - Phone:812-346-5451
Practice Address - Fax:812-346-8456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007859A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194930AMedicaid