Provider Demographics
NPI:1013694538
Name:AMEH, GOVERNOR GODFREY (DDS)
Entity type:Individual
Prefix:
First Name:GOVERNOR
Middle Name:GODFREY
Last Name:AMEH
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 1:1575 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5241
Mailing Address - Country:US
Mailing Address - Phone:989-854-1126
Mailing Address - Fax:
Practice Address - Street 1:799 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-9998
Practice Address - Country:US
Practice Address - Phone:732-955-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79481223G0001X
NJ22DI03049700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist