Provider Demographics
NPI:1902450224
Name:DELUXE DENTISTRY LLC
Entity Type:Organization
Organization Name:DELUXE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GODKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-718-7997
Mailing Address - Street 1:100 FEDERAL CITY RD # 104B
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1664
Mailing Address - Country:US
Mailing Address - Phone:609-718-7997
Mailing Address - Fax:888-575-1408
Practice Address - Street 1:100 FEDERAL CITY RD # 104B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1664
Practice Address - Country:US
Practice Address - Phone:609-718-7997
Practice Address - Fax:888-575-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental