Healthcare Provider Details

I. General information

NPI: 1194883918
Provider Name (Legal Business Name): JEFFREY HAROLD GODEL .D.DS.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N BROAD ST
PHILADELPHIA PA
19140-5007
US

IV. Provider business mailing address

26 WESTMINSTER DR
VOORHEES NJ
08043-3703
US

V. Phone/Fax

Practice location:
  • Phone: 157-074-0022
  • Fax:
Mailing address:
  • Phone: 609-876-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberNJ DI1722
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS021914L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: