Healthcare Provider Details

I. General information

NPI: 1962312645
Provider Name (Legal Business Name): GODEL & ASSOCIATES TN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5357 MOUNT VIEW RD
ANTIOCH TN
37013-2308
US

IV. Provider business mailing address

417 WILLOW BROOK DR
MATTHEWS NC
28105-1831
US

V. Phone/Fax

Practice location:
  • Phone: 704-689-1412
  • Fax: 703-626-3096
Mailing address:
  • Phone: 704-689-1412
  • Fax: 704-626-3096

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: OPERATIONS MANAGER
Credential:
Phone: 704-689-1412