Bruce H. Godick, D.M.D.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

21158-L Issued in PA

Practice address

Fairview Road at 5TH Ave.
Woodlyn, PA 19094

Phone

(610) 833-2660

Fax

(610) 833-5833

NPI assigned

Dec 12, 2006

Sex

Male

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 PA

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 and National Provider Directory roles.

• Woodlyn Dentistry Group LLC

  • Dentist
  • Woodlyn, PA
  • NPI 1356805337
  NPD (past)

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619038940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FAIRVIEW ROAD AT 5TH AVE.",
            "city": "WOODLYN",
            "state": "PA",
            "postal_code": "19094",
            "telephone_number": "610-833-2660",
            "fax_number": "610-833-5833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FAIRVIEW ROAD AT 5TH AVE.",
            "city": "WOODLYN",
            "state": "PA",
            "postal_code": "19094",
            "telephone_number": "610-833-2660",
            "fax_number": "610-833-5833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODICK",
        "first_name": "BRUCE",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "PA",
            "license": "21158-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Godlove Ebong Etape, RPH
• Rachel Marie Garber
• George L Rodriguez MD PC
• George L. Rodriguez, M.D., P.C.
• George L. Rodriguez, M.D., P.C.
• Laura Heberley, RN, M.S., ATC
• Hosana Home Health Care Services, LLC
• Lastasha R Jackson, CRNP
• Randall King, PHARMD
• Kenneth Korab

• Endodontics in Woodlyn, PA
• Providers in Woodlyn, PA by specialty
• Endodontics in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.