Provider Demographics
NPI:1881826279
Name:GODUCO FAMILY DENTISTRY, LTD.
Entity Type:Organization
Organization Name:GODUCO FAMILY DENTISTRY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:V
Authorized Official - Last Name:GODUCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MAGD
Authorized Official - Phone:847-816-0463
Mailing Address - Street 1:281 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2905
Mailing Address - Country:US
Mailing Address - Phone:847-816-0463
Mailing Address - Fax:847-816-0468
Practice Address - Street 1:281 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2905
Practice Address - Country:US
Practice Address - Phone:847-816-0463
Practice Address - Fax:847-816-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty