Provider Demographics
NPI:1629426218
Name:GOETSCH, KARISSA (DDS)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:GOETSCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 JOHNSON AVE N
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-1327
Mailing Address - Country:US
Mailing Address - Phone:218-435-1599
Mailing Address - Fax:
Practice Address - Street 1:109 JOHNSON AVE N
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1327
Practice Address - Country:US
Practice Address - Phone:320-309-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist