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General NPI Number Information
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NPI Number | 1316413495
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Entity Type | Individual
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Provider Name | DR. ANDREW GODOY
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Gender | Male
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 4434 UNIVERSITY PKWY STE G
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4681
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Country | US
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Telephone | 909-887-1533
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Fax |
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Provider Business Mailing Address
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Address Line | 674 W DALTON CT
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City | UPLAND
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State | CA
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Zip | 91784-1424
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Country | US
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Telephone | 725-500-7968
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7741
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102749
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License Number State | CA
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