Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6021 | NV |
NPI | 1063674356 |
---|---|
Provider Name | Amy Goodwin |
First Address | Las Vegas, NV 89117-0501 |
Second Address | Las Vegas, NV 89118-3274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 14/07/2010 |