Provider Demographics
NPI:1326122532
Name:GOSSENAUER, MARTIN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:H
Last Name:GOSSENAUER
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 1:9480 BRIAR VILLAGE PT
Mailing Address - Street 2:SUITE 301
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7922
Mailing Address - Country:US
Mailing Address - Phone:719-522-0123
Mailing Address - Fax:
Practice Address - Street 1:9480 BRIAR VILLAGE PT
Practice Address - Street 2:SUITE 301
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7922
Practice Address - Country:US
Practice Address - Phone:719-522-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71001223P0221X
CO88111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry