Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | TPNU 500 | FL |
NPI | 1013149863 |
---|---|
Provider Name | Dr. Antonio Godoy |
First Address | Davie, FL 33328-2018 |
Second Address | Davie, FL 33328-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 12/08/2009 |