Provider Demographics
NPI:1538488796
Name:GOOLSBEY, KRISTIN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:GOOLSBEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:GRAE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:14807 W 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-0104
Mailing Address - Country:US
Mailing Address - Phone:303-456-4095
Mailing Address - Fax:
Practice Address - Street 1:14807 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-0104
Practice Address - Country:US
Practice Address - Phone:303-456-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00202139122300000X
MND12774122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist