Provider Demographics
NPI:1871203455
Name:ANDREA GODAWA DDS PLLC
Entity type:Organization
Organization Name:ANDREA GODAWA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:GODAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-429-1515
Mailing Address - Street 1:3915 STONEGATE PARK
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9130
Mailing Address - Country:US
Mailing Address - Phone:269-429-1515
Mailing Address - Fax:
Practice Address - Street 1:3915 STONEGATE PARK
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9130
Practice Address - Country:US
Practice Address - Phone:269-429-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty