Provider Demographics
NPI:1962576298
Name:GOODWIN, MELBA JOYCE (RDH)
Entity type:Individual
Prefix:
First Name:MELBA
Middle Name:JOYCE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 TARA RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37180-5039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-302-4200
Practice Address - Fax:615-302-4201
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH3820124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist