# JEFFREY S. MCCOY SUSAN FOWLER GOODWIN D.D.S. INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245447200
- **Authorized official:** JEFFREY S MCCOY (OWNER)
- **Authorized official phone:** (304) 752-4801

## Contact information

- **Practice address:** 127 PROSPERITY LN, LOGAN, WV 25601-3488
- **Practice address phone:** (304) 752-4801
- **Practice address fax:** (304) 752-4825
- **Mailing address:** 127 PROSPERITY LN, LOGAN, WV 25601-3488
- **Mailing address phone:** (304) 752-4801
- **Mailing address fax:** (304) 752-4825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/17/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810006292 | — | WV |