Provider Demographics
NPI:1821173105
Name:GOSS, SHELLI MARGARET
Entity Type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:MARGARET
Last Name:GOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COOLMORE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2850
Mailing Address - Country:US
Mailing Address - Phone:615-566-9916
Mailing Address - Fax:
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-302-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH0000005767124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist