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General NPI Number Information
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NPI Number | 1902669955
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Entity Type | Organization
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Legal Business Name | SIPD GODFREY, PLLC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 901 LARS HOFFMAN XING
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City | GODFREY
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State | IL
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Zip | 62035-4217
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Country | US
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Telephone | 618-481-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 TIMBERLAKE DR
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-4100
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Country | US
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Telephone | 618-791-2794
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Fax |
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Authorized Official
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Title or Position | MEMBER/ OWNER
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Name | DR. CHRISTINE A WOHLFORD
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Credential |
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Telephone | 618-791-2794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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