Provider Demographics
NPI:1275797615
Name:GOSNEY, KIRSTEN MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:MICHELLE
Last Name:GOSNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:MICHELLE
Other - Last Name:GOSNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2009 BIRDCREEK TER
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8005
Mailing Address - Country:US
Mailing Address - Phone:254-773-9007
Mailing Address - Fax:254-773-8051
Practice Address - Street 1:2009 BIRDCREEK TER
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-8005
Practice Address - Country:US
Practice Address - Phone:254-773-9007
Practice Address - Fax:254-773-8051
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86-3125241OtherTAX ID