Provider Demographics
NPI:1417163981
Name:GODFREY, JUDY C (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:C
Last Name:GODFREY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 TWO MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ENOREE
Mailing Address - State:SC
Mailing Address - Zip Code:29335-2102
Mailing Address - Country:US
Mailing Address - Phone:864-969-9730
Mailing Address - Fax:
Practice Address - Street 1:100 OLD CHEROKEE RD
Practice Address - Street 2:SUITE F PMB 14
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9316
Practice Address - Country:US
Practice Address - Phone:803-808-2950
Practice Address - Fax:803-808-5642
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2177124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist