Provider Demographics
NPI:1255060349
Name:GODWIN, PATRICIA (DDS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 FLY CREEK AVE UNIT 3404
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3530
Mailing Address - Country:US
Mailing Address - Phone:607-279-2170
Mailing Address - Fax:
Practice Address - Street 1:23678 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3336
Practice Address - Country:US
Practice Address - Phone:251-928-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
AL0007045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program