Individual
KENNETH LANE GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4964 LAPALCO BLVD, MARRERO, LA 70072-4371
(504) 784-5642
Mailing address
502 PIERREMONT RD, SHREVEPORT, LA 71106-2208
(318) 617-8693
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7312
LA
Other
Enumeration date
04/16/2022
Last updated
05/23/2022
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