Healthcare Provider Details

I. General information

NPI: 1134314800
Provider Name (Legal Business Name): STANLEY MICHAEL GODGES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 W. CECIL AVENUE
DELANO CA
93216
US

IV. Provider business mailing address

4111 PINEWOOD LAKE DR
BAKERSFIELD CA
93309-9308
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-2345
  • Fax: 661-721-6289
Mailing address:
  • Phone: 661-835-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26855
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: