Healthcare Provider Details

I. General information

NPI: 1952850877
Provider Name (Legal Business Name): LAURA E. GODWIN, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N 7TH ST
SMITHFIELD NC
27577-4043
US

IV. Provider business mailing address

415 N 7TH ST
SMITHFIELD NC
27577-4043
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-3636
  • Fax:
Mailing address:
  • Phone: 919-934-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1254
License Number StateNC

VIII. Authorized Official

Name: DR. LAURA ELIZABETH GODWIN
Title or Position: OWNER
Credential: DDS
Phone: 919-522-7720