Provider Demographics
NPI:1225253669
Name:GODKIN, JERRY WAYNE (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WAYNE
Last Name:GODKIN
Suffix:
Gender:M
Credentials:DDS MSD
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Mailing Address - Street 1:17059 STUEBNER AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6210
Mailing Address - Country:US
Mailing Address - Phone:281-444-3999
Mailing Address - Fax:281-444-8079
Practice Address - Street 1:17059 STUEBNER AIRLINE RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-6210
Practice Address - Country:US
Practice Address - Phone:281-444-3999
Practice Address - Fax:281-444-8079
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXTX89471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry