Individual
DR. DUANE KENT GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2515 CHANNING WAY, IDAHO FALLS, ID 83404-7516
(208) 529-4321
(208) 529-8609
Mailing address
3255 WESTERN AVE, AMMON, ID 83406-7629
(208) 529-0456
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1637
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000755500
—
ID
01
—
835199
UNITED CONCORDIA
ID
Enumeration date
02/23/2006
Last updated
05/07/2009
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