Healthcare Provider Details

I. General information

NPI: 1982568432
Provider Name (Legal Business Name): TOM GODFREY DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4818 W LONE MOUNTAIN RD
LAS VEGAS NV
89130-2239
US

IV. Provider business mailing address

4818 W LONE MOUNTAIN RD
LAS VEGAS NV
89130-2239
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-9533
  • Fax: 702-655-9565
Mailing address:
  • Phone: 702-655-9533
  • Fax: 702-655-9565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BETTY VILLASENOR
Title or Position: MANAGER
Credential:
Phone: 702-655-9533