Provider Demographics
NPI:1124110200
Name:GODLEY FAMILY DENTISTY , PA
Entity type:Organization
Organization Name:GODLEY FAMILY DENTISTY , PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:D M D
Authorized Official - Phone:239-262-1535
Mailing Address - Street 1:925 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3879
Mailing Address - Country:US
Mailing Address - Phone:239-262-1535
Mailing Address - Fax:239-261-0730
Practice Address - Street 1:925 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3879
Practice Address - Country:US
Practice Address - Phone:239-262-1535
Practice Address - Fax:239-261-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty