Provider Demographics
NPI:1902669955
Name:SIPD GODFREY, PLLC
Entity Type:Organization
Organization Name:SIPD GODFREY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOHLFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-791-2794
Mailing Address - Street 1:1004 TIMBERLAKE DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4100
Mailing Address - Country:US
Mailing Address - Phone:618-791-2794
Mailing Address - Fax:
Practice Address - Street 1:901 LARS HOFFMAN XING
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-4217
Practice Address - Country:US
Practice Address - Phone:618-481-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty