Provider Demographics
NPI:1437881620
Name:GODEFOY, MARICEL (DMD)
Entity Type:Individual
Prefix:
First Name:MARICEL
Middle Name:
Last Name:GODEFOY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 W 53RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2417
Mailing Address - Country:US
Mailing Address - Phone:954-740-0615
Mailing Address - Fax:
Practice Address - Street 1:870 W 53RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2417
Practice Address - Country:US
Practice Address - Phone:954-740-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN271061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice