Provider Demographics
NPI:1255532057
Name:GODORECCI, JAMES ALFRED JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALFRED
Last Name:GODORECCI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1408
Mailing Address - Country:US
Mailing Address - Phone:610-664-2502
Mailing Address - Fax:
Practice Address - Street 1:12 S VALLEY RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1408
Practice Address - Country:US
Practice Address - Phone:610-664-2502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028678L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice