Provider Demographics
NPI:1720009863
Name:FUNARI, GODFREY JOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:GODFREY
Middle Name:JOEL
Last Name:FUNARI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BRYN MAWR MEDICAL OFFICE BUILDING, 135 S. BRYN MAWR AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3155
Mailing Address - Country:US
Mailing Address - Phone:610-688-6682
Mailing Address - Fax:610-971-0481
Practice Address - Street 1:BRYN MAWR MEDICAL OFFICE BUILDING, 135 S. BRYN MAWR AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-688-6682
Practice Address - Fax:610-971-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023425L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery