Provider Demographics
NPI:1851566392
Name:G. WILLIAM GODFREY, DDS LEE R. REDDISH, DDS PLLC
Entity Type:Organization
Organization Name:G. WILLIAM GODFREY, DDS LEE R. REDDISH, DDS PLLC
Other - Org Name:VALLEY VIEW FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PART-OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDDISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-233-8750
Mailing Address - Street 1:1980 BIRDIE THOMPSON DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2755
Mailing Address - Country:US
Mailing Address - Phone:208-233-8750
Mailing Address - Fax:208-233-8751
Practice Address - Street 1:1980 BIRDIE THOMPSON DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2755
Practice Address - Country:US
Practice Address - Phone:208-233-8750
Practice Address - Fax:208-233-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental