Provider Demographics
NPI:1346245784
Name:SANNEN, GODELIEVE MARIA JOZEF (DDS)
Entity Type:Individual
Prefix:DR
First Name:GODELIEVE
Middle Name:MARIA JOZEF
Last Name:SANNEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1530
Mailing Address - Country:US
Mailing Address - Phone:212-245-7572
Mailing Address - Fax:212-724-5779
Practice Address - Street 1:147 W 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1530
Practice Address - Country:US
Practice Address - Phone:212-245-7572
Practice Address - Fax:212-724-5779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist