Individual
DANIEL GODFREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2501
(217) 326-1297
(217) 326-1300
Mailing address
1501 HILLSHIRE DR, URBANA, IL 61802-7808
(317) 383-9097
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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