Provider Demographics
NPI:1083007694
Name:GODLEY, DANIELLE (EPDH)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:GODLEY
Suffix:
Gender:F
Credentials:EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S CENTRAL VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-1509
Mailing Address - Country:US
Mailing Address - Phone:541-821-0902
Mailing Address - Fax:
Practice Address - Street 1:365 S CENTRAL VALLEY DR
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-1509
Practice Address - Country:US
Practice Address - Phone:541-821-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-07
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5019124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist