Provider Demographics
NPI:1598177891
Name:GOETZ, DUSTIN DOMINIC (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:DOMINIC
Last Name:GOETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E GREENFIELD LN STE 100
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6597
Mailing Address - Country:US
Mailing Address - Phone:701-223-7822
Mailing Address - Fax:701-223-7844
Practice Address - Street 1:202 E GREENFIELD LN STE 100
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6597
Practice Address - Country:US
Practice Address - Phone:701-223-7822
Practice Address - Fax:701-223-7844
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPT15745207LP2900X
ND15745207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine