Provider Demographics
NPI:1578893590
Name:TRISHA T. GOLDSBY D.D.S., P.S.
Entity Type:Organization
Organization Name:TRISHA T. GOLDSBY D.D.S., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:TERUMI
Authorized Official - Last Name:GOLDSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PS
Authorized Official - Phone:360-748-6624
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0120
Mailing Address - Country:US
Mailing Address - Phone:360-748-6624
Mailing Address - Fax:360-748-4132
Practice Address - Street 1:388 SW 13TH ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3609
Practice Address - Country:US
Practice Address - Phone:360-748-6624
Practice Address - Fax:360-748-4132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRISHA T. GOLDSBY D.D.S., P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036678Medicaid