Provider Demographics
NPI:1427153840
Name:GODLEWSKI, BRETT ZYGMUNT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ZYGMUNT
Last Name:GODLEWSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:215-550-7186
Mailing Address - Fax:215-646-6166
Practice Address - Street 1:6100 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1423
Practice Address - Country:US
Practice Address - Phone:215-224-4343
Practice Address - Fax:215-224-2447
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84081223G0001X
WV40171223S0112X
PADS039481122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist