Provider Demographics
NPI:1841474509
Name:GREGORY A GODLEY DMD PA
Entity type:Organization
Organization Name:GREGORY A GODLEY DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-633-0220
Mailing Address - Street 1:162 GINGER QUILL CIR
Mailing Address - Street 2:
Mailing Address - City:BILTMORE LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8475
Practice Address - Country:US
Practice Address - Phone:828-645-5009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental