Provider Demographics
NPI:1497900559
Name:ALAN GODEL D.D.S PA
Entity Type:Organization
Organization Name:ALAN GODEL D.D.S PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS PA
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:GODEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-847-4332
Mailing Address - Street 1:417 WILLOW BROOK DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1831
Mailing Address - Country:US
Mailing Address - Phone:704-847-4332
Mailing Address - Fax:
Practice Address - Street 1:417 WILLOW BROOK DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1831
Practice Address - Country:US
Practice Address - Phone:704-847-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALAN GODEL D.D.S PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-17
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75641223G0001X
NC47361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty