Provider Demographics
NPI:1730856808
Name:GODLEY FAMILY ORTHODONTICS LLC
Entity type:Organization
Organization Name:GODLEY FAMILY ORTHODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:765-425-1321
Mailing Address - Street 1:12036 N MICHIGAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8782
Mailing Address - Country:US
Mailing Address - Phone:317-913-2828
Mailing Address - Fax:
Practice Address - Street 1:12036 N MICHIGAN RD STE 100
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8782
Practice Address - Country:US
Practice Address - Phone:317-913-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental