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General NPI Number Information
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NPI Number | 1861185860
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Entity Type | Individual
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Provider Name | DANIEL GODFREY DDS
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Gender | Male
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 07/14/2024
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Provider Practice Location Address
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Address Line | 611 W PARK ST
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City | URBANA
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State | IL
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Zip | 61801-2501
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Country | US
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Telephone | 217-326-1297
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Fax | 217-326-1300
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Provider Business Mailing Address
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Address Line | 1501 HILLSHIRE DR
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City | URBANA
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State | IL
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Zip | 61802-7808
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Country | US
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Telephone | 317-383-9097
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12014089A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 018002288
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License Number State | IL
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