MEDICARE: DR. BRETT ZYGMUNT GODLEWSKI DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8408	KY
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4017	WV
3	122300000X	Dentist	DS039481	PA
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS039481	PA

General Provider Information

NPI Number	:	1427153840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT ZYGMUNT GODLEWSKI DMD

Provider Business Mailing Address
First Line	:	401 COMMERCE DR
Second Line	:	SUITE 108
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-2714
Country	:	US
Telephone Number	:	215-550-7186
Fax Number	:	215-646-6166

Provider Business Practice Location Address
First Line	:	6100 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1423
Country	:	US
Telephone Number	:	215-224-4343
Fax Number	:	215-224-2447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	02/27/2014

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