Provider Demographics
NPI:1538510748
Name:GODFREY, CHRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:GODFREY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 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:801-546-2413
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
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6595615-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist