Provider Demographics
NPI:1316043169
Name:GOSS, PATRICK DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DAVID
Last Name:GOSS
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 1:1342 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-9071
Mailing Address - Country:US
Mailing Address - Phone:720-272-6558
Mailing Address - Fax:
Practice Address - Street 1:1342 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-9071
Practice Address - Country:US
Practice Address - Phone:720-272-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO51501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOTP23064AMedicaid