Individual
DR. KEN G GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, PA
Contact information
Practice address
403 NORTH THIRD STREET, BOONEVILLE, MS 38829
(662) 728-8171
(662) 728-1093
Mailing address
PO BOX 877, BOONEVILLE, MS 38829-0877
(662) 728-8171
(662) 728-1093
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1971-82
MS
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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