Provider Demographics
NPI:1073660346
Name:GOSS, JENNIFER (DDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GOSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ASCOT DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3408
Mailing Address - Country:US
Mailing Address - Phone:916-786-7070
Mailing Address - Fax:916-786-5696
Practice Address - Street 1:125 ASCOT DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3408
Practice Address - Country:US
Practice Address - Phone:916-786-7070
Practice Address - Fax:916-786-5696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics