Provider Demographics
NPI:1669669719
Name:GODES, STACY ALBINDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ALBINDER
Last Name:GODES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:ALBINDER
Other - Last Name:BOETTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:146 CADMUS ST
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2029
Mailing Address - Country:US
Mailing Address - Phone:623-341-9228
Mailing Address - Fax:
Practice Address - Street 1:317 N EL CAMINO REAL
Practice Address - Street 2:SUITE 106
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2811
Practice Address - Country:US
Practice Address - Phone:760-536-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5159122300000X
CA59249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist