Provider Demographics
NPI:1396818142
Name:GODFREY, VALERIE MARGARET (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:MARGARET
Last Name:GODFREY
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 TRAVIS BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4839
Mailing Address - Country:US
Mailing Address - Phone:707-429-5201
Mailing Address - Fax:707-429-5202
Practice Address - Street 1:1225 TRAVIS BLVD STE H
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4839
Practice Address - Country:US
Practice Address - Phone:707-429-5201
Practice Address - Fax:707-429-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics