Individual
DR. STACY L GOODWILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1815 UNIVERSITY DR S, SUITE 3, FARGO, ND 58103-4900
(701) 237-3583
Mailing address
1630 3RD ST W, WEST FARGO, ND 58078-4269
(701) 281-0588
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1937
ND
1223G0001X
General Practice Dentistry
D11537
MN
Other
Enumeration date
04/01/2006
Last updated
07/08/2007
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