1851566392 NPI number — G. WILLIAM GODFREY, DDS LEE R. REDDISH, DDS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851566392 NPI number — G. WILLIAM GODFREY, DDS LEE R. REDDISH, DDS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G. WILLIAM GODFREY, DDS LEE R. REDDISH, DDS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALLEY VIEW FAMILY DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851566392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1980 BIRDIE THOMPSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-2755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-233-8750
Provider Business Mailing Address Fax Number:
208-233-8751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1980 BIRDIE THOMPSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-2755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-233-8750
Provider Business Practice Location Address Fax Number:
208-233-8751
Provider Enumeration Date:
04/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
REDDISH
Authorized Official First Name:
LEE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PART-OWNER DENTIST
Authorized Official Telephone Number:
208-233-8750

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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