Provider Demographics
NPI:1700272184
Name:GODLEY, DANIELLE NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:NICOLE
Last Name:GODLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:13390 OVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6314
Mailing Address - Country:US
Mailing Address - Phone:765-565-4249
Mailing Address - Fax:
Practice Address - Street 1:13390 OVERVIEW DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6314
Practice Address - Country:US
Practice Address - Phone:765-565-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308081223X0400X
IN12013284A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics