Provider Demographics
NPI:1508000688
Name:GOETSCH, ELIZABETH LYNN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LYNN
Last Name:GOETSCH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N. CARROLL ST.
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2285
Mailing Address - Country:US
Mailing Address - Phone:608-258-2470
Mailing Address - Fax:608-258-2482
Practice Address - Street 1:211 N CARROLL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2211
Practice Address - Country:US
Practice Address - Phone:608-258-2470
Practice Address - Fax:608-258-2482
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001279-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist