Provider Demographics
NPI:1720646599
Name:GOODWIN DENTISTRY AND MEDICINE, LLC
Entity type:Organization
Organization Name:GOODWIN DENTISTRY AND MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, DMD
Authorized Official - Phone:407-671-2300
Mailing Address - Street 1:3025 ALOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3702
Mailing Address - Country:US
Mailing Address - Phone:407-671-2300
Mailing Address - Fax:407-671-2827
Practice Address - Street 1:3025 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3702
Practice Address - Country:US
Practice Address - Phone:407-671-2300
Practice Address - Fax:407-671-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1831579457Medicaid