Active NPI
Allen Edward Godell, DDS
- General Practice Dentistry
- Dearborn, MI
National Provider Identifier
1003093048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10796
- Practice address
- 23100 Cherry Hill St
Suite 3
Dearborn, MI 48124-1493 - Phone
- (313) 274-6404
- Fax
- (313) 562-6969
- NPI assigned
- Jan 22, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10796 | MI | Primary |
Addresses
Primary practice location
23100 Cherry Hill St
Suite 3
Dearborn, MI 48124-1493
Mailing address
23100 Cherry Hill St
Suite 3
Dearborn, MI 48124-1493
Phone (313) 274-6404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10796 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200960000000",
"number": "1003093048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23100 CHERRY HILL ST",
"address_2": "SUITE 3",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241493",
"telephone_number": "313-274-6404",
"fax_number": "313-562-6969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23100 CHERRY HILL ST",
"address_2": "SUITE 3",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241493",
"telephone_number": "313-274-6404",
"fax_number": "313-562-6969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GODELL",
"first_name": "ALLEN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-22",
"last_updated": "2008-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "10796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.