Provider Demographics
NPI:1851774723
Name:GOETTSCHE, ERIC REID (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:REID
Last Name:GOETTSCHE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 E CALDERWOOD DR # 110
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7440
Mailing Address - Country:US
Mailing Address - Phone:208-501-8860
Mailing Address - Fax:208-501-8862
Practice Address - Street 1:53 E CALDERWOOD DR # 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7440
Practice Address - Country:US
Practice Address - Phone:208-501-8860
Practice Address - Fax:208-501-8862
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD50001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice