Organization
JEFFREY S. MCCOY SUSAN FOWLER GOODWIN D.D.S. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY S MCCOY (OWNER)
(304) 752-4801
Entity
Organization
Contact information
Practice address
127 PROSPERITY LN, LOGAN, WV 25601-3488
(304) 752-4801
(304) 752-4825
Mailing address
127 PROSPERITY LN, LOGAN, WV 25601-3488
(304) 752-4801
(304) 752-4825
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006292
—
WV
Enumeration date
05/17/2007
Last updated
08/22/2020
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