Provider Demographics
NPI:1134314800
Name:GODGES, STANLEY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MICHAEL
Last Name:GODGES
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 1:4111 PINEWOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-9308
Mailing Address - Country:US
Mailing Address - Phone:661-835-7036
Mailing Address - Fax:
Practice Address - Street 1:2737 W. CECIL AVENUE
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93216
Practice Address - Country:US
Practice Address - Phone:661-721-2345
Practice Address - Fax:661-721-6289
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist