Jude P Goodwin, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

40384 Issued in TX

Practice address

1710 Briarcrest Dr Ste 111
Bryan, TX 77802-2871

Phone

(979) 704-6408

Fax

(979) 704-6409

NPI assigned

Jun 20, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brazos Valley Dental Group, LLC

  • Dental Clinic/Center
  • College Station, TX
  • NPI 1306557871
  NPD
• Bryan Dental Group PLLC

  • General Practice Dentistry
  • Bryan, TX
  • NPI 1851147367
  NPD
• Brian S Black DDS PLLC

  • General Practice Dentistry
  • College Station, TX
  • NPI 1619277894
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1396589800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 ROCK PRAIRIE RD STE 100",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778458796",
            "telephone_number": "979-695-8000",
            "fax_number": "979-314-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 BRIARCREST DR STE 111",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022871",
            "telephone_number": "979-704-6408",
            "fax_number": "979-704-6409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "JUDE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "40384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abbie Sue Gonzalez, RN
• Alexia Gonzalez, M.A, LPC
• Grantlan Layton Goodale, PHARMD, RPH
• Jennifer Ann Goode
• Takayius Gooden
• Fara Diane Goodwyn, M.ED., BCBA
• Gordon Pratt Jr DDS Ms PA
• Amber Gordon
• Grace Pongnea Gorman
• Cynthia Ann Gosnell, PH.D.

• General Practice Dentistry in Bryan, TX
• Providers in Bryan, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.