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General NPI Number Information
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NPI Number | 1477355881
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Entity Type | Individual
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Provider Name | MINDI JOY GODFREY
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Gender | Female
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 810 E JAMES LEE BLVD
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City | CRESTVIEW
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State | FL
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Zip | 32539-3118
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Country | US
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Telephone | 850-689-5593
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 SWEETBRIAR STA
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-7052
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Country | US
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Telephone | 850-689-5593
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH20596
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License Number State | FL
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