Healthcare Provider Details

I. General information

NPI: 1831052349
Provider Name (Legal Business Name): GODEL & ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 COUNTRY CLUB RD
WINSTON SALEM NC
27104-3518
US

IV. Provider business mailing address

4550 COUNTRY CLUB RD
WINSTON SALEM NC
27104-3518
US

V. Phone/Fax

Practice location:
  • Phone: 336-738-0111
  • Fax:
Mailing address:
  • Phone: 336-738-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ERICA BEACH
Title or Position: OPERATION MANAGER
Credential:
Phone: 704-689-1412