Healthcare Provider Details

I. General information

NPI: 1154094993
Provider Name (Legal Business Name): MICHAEL GODINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 DENTAL CO/US ARMY DENTAC-KOREA UNIT 15652
APO AP
96271
US

IV. Provider business mailing address

CARL R. DARNALL ARMY MEDICAL CENTER 590 MEDICAL CENTER ROAD
FORT HOOD TX
76544-5060
US

V. Phone/Fax

Practice location:
  • Phone: 580-558-2795
  • Fax:
Mailing address:
  • Phone: 989-482-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12358028-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: