Provider Demographics
NPI:1376743906
Name:GODLEY, JAMES B JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:GODLEY
Suffix:JR
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 1:19607 W CATAWBA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4002
Mailing Address - Country:US
Mailing Address - Phone:704-892-4431
Mailing Address - Fax:
Practice Address - Street 1:19607 W CATAWBA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4002
Practice Address - Country:US
Practice Address - Phone:704-892-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-22
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice