Individual
DR. EMERSON G GODBOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1310 PONDEROSA DR STE A, SANDPOINT, ID 83864-5073
(208) 263-7641
(208) 265-4333
Mailing address
1310 PONDEROSA DR STE A, SANDPOINT, ID 83864-5073
(208) 263-7641
(406) 452-4064
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7811
MT
122300000X
Dentist
DEN-DEN-LIC-7811
MT
1223G0001X
General Practice Dentistry
Primary
5219
ID
Other
Enumeration date
07/01/2014
Last updated
03/05/2024
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