Organization
KEN GOODWIN, DMD, PA
Active
Other names
Park Place Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEN G GOODWIN DMD,PA (OWNER)
(662) 728-8171
Entity
Organization
Contact information
Practice address
403 N THIRD ST, BOONEVILLE, MS 38829-1609
(662) 728-8171
(662) 728-1093
Mailing address
403 N THIRD ST, BOONEVILLE, MS 38829-1609
(662) 728-8171
(662) 728-1093
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1971-82
MS
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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