Emerson G Godbolt, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5219 Issued in ID

Practice address

1310 Ponderosa Dr Ste a
Sandpoint, ID 83864-5073

Phone

(208) 263-7641

Fax

(208) 265-4333

NPI assigned

Jul 1, 2014

Last updated

Mar 5, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Loftus Family Dental - Sandpoint PLLC

  • General Practice Dentistry
  • Sandpoint, ID
  • NPI 1497148860
  NPD
• Kevin B. Johnson, DDS

  • Dentist
  • Sandpoint, ID
  • NPI 1568516714
  NPD (past)
• Great Falls Dental Associates LLC

  • General Practice Dentistry
  • Great Falls, MT
  • NPI 1275895039
  NPD (past)
• Montana Kids Dental LLC

  • Pediatric Dentistry
  • Helena, MT
  • NPI 1114501897
  NPD (past)

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1902211725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 PONDEROSA DR STE A",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645073",
            "telephone_number": "208-263-7641",
            "fax_number": "406-452-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 PONDEROSA DR STE A",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645073",
            "telephone_number": "208-263-7641",
            "fax_number": "208-265-4333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 2nd Ave N Ste 100",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "59401",
            "country_code": "US",
            "telephone_number": "406-452-8740",
            "fax_number": "406-452-4064",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5901 N Lidgerwood St Ste 233",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992081122",
            "country_code": "US",
            "telephone_number": "509-489-4763",
            "fax_number": "509-489-4767",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1050 Road Runner St",
            "address_purpose": "LOCATION",
            "city": "Helena",
            "state": "MT",
            "postal_code": "596020543",
            "country_code": "US",
            "telephone_number": "406-442-1377",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GODBOLT",
        "first_name": "EMERSON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-01",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MT",
            "license": "7811",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MT",
            "license": "DEN-DEN-LIC-7811",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "5219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasper Gibson
• Karen Maurine Glaeser, LPC
• Glidden Counseling, LLC
• Brom Glidden, M.A.
• Phillip Arnold Glidden, DDS
• Arthur S Goldblum, LAC DIPLAC
• Stacey A Good, D.O.
• Mari Goodpaster, LMT
• Susan R Gordon, LPC
• Erin Kathleen Gray, LPC

• General Practice Dentistry in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.