Individual
DR. JEREMY GRANT GODDERIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1792 W 1700 S, SYRACUSE, UT 84075-9143
(801) 698-5892
Mailing address
1352 DORAL DR, SYRACUSE, UT 84075-9739
(801) 773-8579
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6250404-9922
UT
Other
Enumeration date
08/31/2006
Last updated
06/10/2008
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