Provider Demographics
NPI:1740621713
Name:GOODWIN, LAURA GIOIA (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:GIOIA
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GIOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:10131 WILSKY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5837
Mailing Address - Country:US
Mailing Address - Phone:813-792-8211
Mailing Address - Fax:
Practice Address - Street 1:10131 WILSKY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-5837
Practice Address - Country:US
Practice Address - Phone:813-792-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 201991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice