Provider Demographics
NPI:1497320121
Name:GODFREY FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:GODFREY FAMILY DENTAL LLC
Other - Org Name:LIFETIME FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-663-6144
Mailing Address - Street 1:2087 N 725 W
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3465
Mailing Address - Country:US
Mailing Address - Phone:801-663-6144
Mailing Address - Fax:801-546-1900
Practice Address - Street 1:475 N 300 W STE 1
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-3112
Practice Address - Country:US
Practice Address - Phone:801-546-2413
Practice Address - Fax:801-546-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental