Active NPI
Matthew P Godfrey, D.D.S.
- Dentist
- Pocatello, ID
National Provider Identifier
1215376504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D4490
- Practice address
- 1598 Delphic Way
Pocatello, ID 83201-2232 - Phone
- (208) 637-1300
- Fax
- (208) 637-0798
- NPI assigned
- Jun 19, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D4490 | ID | Primary |
Addresses
Primary practice location
1598 Delphic Way
Pocatello, ID 83201-2232
Mailing address
1598 Delphic Way
Pocatello, ID 83201-2232
Phone (208) 637-1300
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D4490 | ID | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471392000000",
"number": "1215376504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1598 DELPHIC WAY",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012232",
"telephone_number": "208-637-1300",
"fax_number": "208-637-0798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1598 DELPHIC WAY",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012232",
"telephone_number": "208-637-1300",
"fax_number": "208-637-0798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GODFREY",
"first_name": "MATTHEW",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-06-19",
"last_updated": "2016-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D4490",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.