Provider Demographics
NPI:1073729950
Name:GOTTSCHE, GERMAINE NICKOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:NICKOLE
Last Name:GOTTSCHE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 PROMENADE PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-5367
Mailing Address - Country:US
Mailing Address - Phone:228-392-1960
Mailing Address - Fax:228-392-1959
Practice Address - Street 1:3950 PROMENADE PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-5367
Practice Address - Country:US
Practice Address - Phone:228-392-1960
Practice Address - Fax:228-392-1959
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3295-041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice