Healthcare Provider Details

I. General information

NPI: 1013149863
Provider Name (Legal Business Name): ANTONIO GODOY DDS., MS.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

IV. Provider business mailing address

3200 S UNIVERSITY DR
DAVIE FL
33328-2018
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1908
  • Fax: 954-262-7355
Mailing address:
  • Phone: 954-262-1908
  • Fax: 954-262-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberTPNU 500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: