Provider Demographics
NPI:1154304152
Name:GOSSLER, JOSEPH M (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:GOSSLER
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 1:104 39TH AVE SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3621
Mailing Address - Country:US
Mailing Address - Phone:253-841-1386
Mailing Address - Fax:253-841-5995
Practice Address - Street 1:104 39TH AVE SW
Practice Address - Street 2:SUITE E
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3621
Practice Address - Country:US
Practice Address - Phone:253-841-1386
Practice Address - Fax:253-841-5995
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA52541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20108OtherDEPT OF LABOR &INDUSTRIES
WAG00670OtherREGENCE
WA5549001Medicaid