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Individual
DANIEL GODFREY
Active
Individual
DANIEL GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
12014089A
IN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
018002288
IL
Other
Enumeration date
05/26/2023
Last updated
07/14/2024
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