| Jeffrey S. Mccoy Susan Fowler Goodwin D.d.s. Inc. | |
|
127 Prosperity Ln Logan WV 25601-3488 | |
| (304) 752-4801 | |
| (304) 752-4825 |
| Full Name | Jeffrey S. Mccoy Susan Fowler Goodwin D.d.s. Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 127 Prosperity Ln, Logan, West Virginia |
| Authorized Official Name and Position | Jeffrey S Mccoy (OWNER) |
| Authorized Official Contact | 3047524801 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey S. Mccoy Susan Fowler Goodwin D.d.s. Inc. 127 Prosperity Ln Logan WV 25601-3488 Ph: (304) 752-4801 | Jeffrey S. Mccoy Susan Fowler Goodwin D.d.s. Inc. 127 Prosperity Ln Logan WV 25601-3488 Ph: (304) 752-4801 |
| NPI Number | 1245447200 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245447200 | NPI | - | NPPES |
| 3810006292 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Hobert L. Mack, D.d.s., Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 Stratton St, Logan, WV 25601 Phone: 304-752-3563 Fax: 304-752-3148 |