Individual
MR. BROOKS A GODWIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
315 W GEORGIA RD, SIMPSONVILLE, SC 29681-2401
(864) 963-3601
(864) 963-2598
Mailing address
PO BOX 799, SIMPSONVILLE, SC 29681-0799
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3465
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1363833
UNITED CONCORDIA INS
—
Enumeration date
12/05/2005
Last updated
07/08/2007
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