Provider Demographics
NPI:1558815365
Name:GODKO, MAXIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:
Last Name:GODKO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 MONMOUTH RD
Mailing Address - Street 2:ROUTE 537
Mailing Address - City:WRIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08562-2125
Mailing Address - Country:US
Mailing Address - Phone:609-758-2244
Mailing Address - Fax:609-758-6773
Practice Address - Street 1:100 FEDERAL CITY RD # 104B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1664
Practice Address - Country:US
Practice Address - Phone:609-718-7997
Practice Address - Fax:888-575-1408
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026437001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice