Provider Demographics
NPI:1568561231
Name:RONALD F GODAT DDS MS PC
Entity type:Organization
Organization Name:RONALD F GODAT DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:GODAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:423-239-3993
Mailing Address - Street 1:210 LOCKPORT CIRCLE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-239-3993
Mailing Address - Fax:423-239-9499
Practice Address - Street 1:210 LOCKPORT CIRCLE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-239-3993
Practice Address - Fax:423-239-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS20611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty