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General NPI Number Information
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NPI Number | 1962312645
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Entity Type | Organization
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Legal Business Name | GODEL & ASSOCIATES TN PLLC
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 5357 MOUNT VIEW RD
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City | ANTIOCH
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State | TN
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Zip | 37013-2308
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Country | US
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Telephone | 704-689-1412
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Fax | 703-626-3096
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Provider Business Mailing Address
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Address Line | 417 WILLOW BROOK DR
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City | MATTHEWS
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State | NC
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Zip | 28105-1831
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Country | US
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Telephone | 704-689-1412
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Fax | 704-626-3096
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ERICA BEACH
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Credential |
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Telephone | 704-689-1412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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