Brian James Goodwine, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

3601859922 Issued in UT

Practice address

217 S 100 West
Monticello, UT 84535

Phone

(435) 587-2528

Fax

(435) 587-3585

NPI assigned

Dec 14, 2006

Last updated

Mar 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: brian.goodwine.1@16098.direct.athenahealth.com

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.

• Utah Navajo Health System, Incorporated

  dba Montezuma Creek Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Montezuma Creek, UT
  • NPI 1811991151
  Medicare reassignment NPD
• San Juan Dental

  • General Practice Dentistry
  • Monticello, UT
  • NPI 1447465141
  NPD (past)
• Utah Navajo Health System, Incorporated

  dba San Juan Family Dental

  • General Practice Dentistry
  • Monticello, UT
  • NPI 1346797909
  NPD (past)
• Utah Navajo Health System, Incorporated

  dba Blanding Family Practice Community Health Center

  • Family Medicine Physician
  • Blanding, UT
  • NPI 1457489486
  NPD (past)
• Utah Navajo Health System, Incorporated

  • Land Ambulance
  • Montezuma Creek, UT
  • NPI 1598198434
  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1891857223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "845340130",
            "telephone_number": "435-651-3700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S 100 WEST",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "84535",
            "telephone_number": "435-587-2528",
            "fax_number": "435-587-3585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWINE",
        "first_name": "BRIAN",
        "middle_name": "JAMES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "3601858903",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "3601859922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Zeb Crofts, DO
• Steven Floyd Duke, OTR
• Nicole Marie Fox, PA-C
• Blen Arlow Freestone, P.A.
• Paul Goodrich, DPT
• Ihc Health Services Inc (IMED Utah Heart - Monticello)
• Kelly Marvin Jeppesen, MD
• Michael James Judi, DMD
• Kayenta Dental (Monticello Dental)
• Dylan Naylor Knight, DC

• Dentist in Monticello, UT
• Providers in Monticello, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.