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Organization
EXCELLENCE IN DENTISTRY PA
Active
Organization
EXCELLENCE IN DENTISTRY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUANE KENT GODFREY DDS (DENTIST)
(208) 529-4321
Entity
Organization
Contact information
Practice address
2515 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 529-4321
(208) 529-8609
Mailing address
2515 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 529-4321
(208) 529-8609
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1637
ID
1223G0001X
General Practice Dentistry
D3983
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000755500
—
ID
05
—
807539000
—
ID
Enumeration date
08/03/2006
Last updated
12/17/2010
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