Andrea Godawa, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

2901021551 Issued in MI

Practice address

57418 County Road 681
Hartford, MI 49057-9421

Phone

(269) 621-6159

Fax

(269) 621-2725

NPI assigned

Jun 10, 2015

Last updated

Jul 26, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Andrea Godawa DDS PLLC

  dba Modern Dentistry Associates

  • General Practice Dentistry
  • Saint Joseph, MI
  • NPI 1871203455
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1568843175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57418 COUNTY ROAD 681",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "490579421",
            "telephone_number": "269-621-6159",
            "fax_number": "269-621-2725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57418 COUNTY ROAD 681",
            "city": "HARTFORD",
            "state": "MI",
            "postal_code": "490579421",
            "telephone_number": "269-621-6159",
            "fax_number": "269-621-2725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODAWA",
        "first_name": "ANDREA",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-10",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901021551",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley First, PHARMD
• Nora Adessa Fox-Wentz, MASTER'S LTD. PSYCHO
• Ruth Wellington Fuentes, LMSW
• Tamara Nichole Gaishin, PA-C
• Danielle Gatny, LMSW, MSW
• Hallie Elizabeth Gonzalez, CNM
• Laura Irene Gonzalez, NP
• Seth William Griffin, DDS
• Dalena Haddock, B.S
• Shelby Hall

• Dentist in Hartford, MI
• Providers in Hartford, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.