Merle Franklin Godfrey III, DDS

Individual provider Active NPI General Practice Dentistry · Loomis, CA

NPI 1003004698 · NPPES record last updated Apr 18, 2014

Key facts

NPI
1003004698
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
38684 (CA)
Practice address
3669 Taylor Rd
#2178
Loomis, CA 95650-7400
Phone
(916) 660-0907
NPI assigned
Oct 9, 2007
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
38684CAMDPhysical Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 38684 CA Yes

Addresses

Primary practice location

3669 Taylor Rd
#2178
Loomis, CA 95650-7400

Mailing address

PO Box 2178
Loomis, CA 95650-2178

Other providers in Loomis, CA

All providers in Loomis, CA · General Practice Dentistry in California

Sources for this page

Verify at the official NPI Registry.