Provider Demographics
NPI:1003004698
Name:GODFREY, MERLE FRANKLIN III (DDS)
Entity type:Individual
Prefix:DR
First Name:MERLE
Middle Name:FRANKLIN
Last Name:GODFREY
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2178
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-2178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3669 TAYLOR RD
Practice Address - Street 2:#2178
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-7400
Practice Address - Country:US
Practice Address - Phone:916-660-0907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice