Ken G Goodwin, DMD, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1971-82 Issued in MS

Practice address

403 North Third Street
Booneville, MS 38829

Phone

(662) 728-8171

Fax

(662) 728-1093

NPI assigned

Oct 5, 2006

Sex

Male

Sole proprietor

Yes

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

Credentials

Physician Assistant

State licenses

Practice roles

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

• Ken Goodwin, DMD, PA

  dba Park Place Dental

  • General Practice Dentistry
  • Booneville, MS
  • NPI 1548673320
  NPD (past) Authorized official

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1902992043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 877",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388290877",
            "telephone_number": "662-728-8171",
            "fax_number": "662-728-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 NORTH THIRD STREET",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "38829",
            "telephone_number": "662-728-8171",
            "fax_number": "662-728-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "KEN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DMD, PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "1971-82",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kellye Garrett, APMHNP
• Nestly Gates, BSW
• Gilbert's Hospice Care, LLC (Gentiva)
• Aysha Glidewell
• Danita Godwin, CCSS
• Dedrick Michelle Grady, MSW
• David N Greenhaw, M. D.
• Stacey Hall
• Hancock Internal Medicine Services, LLC
• Mary Grace Hancock, M.D.

• General Practice Dentistry in Booneville, MS
• Providers in Booneville, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; 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.