Provider Demographics
NPI:1053311522
Name:GOSCH, GREGORY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:GOSCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4474
Mailing Address - Country:US
Mailing Address - Phone:360-659-7617
Mailing Address - Fax:360-653-4634
Practice Address - Street 1:4825 GROVE ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4474
Practice Address - Country:US
Practice Address - Phone:360-659-7617
Practice Address - Fax:360-653-4634
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA48681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice