Healthcare Provider Details

I. General information

NPI: 1497320121
Provider Name (Legal Business Name): GODFREY FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 N 300 W STE 1
KAYSVILLE UT
84037-3112
US

IV. Provider business mailing address

2087 N 725 W
CENTERVILLE UT
84014-3465
US

V. Phone/Fax

Practice location:
  • Phone: 801-546-2413
  • Fax: 801-546-1900
Mailing address:
  • Phone: 801-663-6144
  • Fax: 801-546-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER ROBERT GODFREY
Title or Position: OWNER
Credential: DMD
Phone: 801-663-6144