Provider Demographics
NPI:1104183730
Name:GODLEY, GARY ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ARTHUR
Last Name:GODLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3879
Mailing Address - Country:US
Mailing Address - Phone:239-262-1535
Mailing Address - Fax:239-261-0730
Practice Address - Street 1:925 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3879
Practice Address - Country:US
Practice Address - Phone:239-262-1535
Practice Address - Fax:239-261-0730
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist