Provider Demographics
NPI:1497076913
Name:GOSS, ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
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 1:5112 W TAFT RD STE N
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4873
Mailing Address - Country:US
Mailing Address - Phone:315-652-3811
Mailing Address - Fax:315-652-3624
Practice Address - Street 1:5112 W TAFT RD STE N
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4873
Practice Address - Country:US
Practice Address - Phone:315-652-3811
Practice Address - Fax:315-652-3624
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist