Provider Demographics
NPI:1922271832
Name:GOSCH FAMILY DENTAL P.C.
Entity Type:Organization
Organization Name:GOSCH FAMILY DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-884-2400
Mailing Address - Street 1:9850 S 168TH AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136
Mailing Address - Country:US
Mailing Address - Phone:402-884-2400
Mailing Address - Fax:402-884-8788
Practice Address - Street 1:9850 S 168TH AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136
Practice Address - Country:US
Practice Address - Phone:402-884-2400
Practice Address - Fax:402-884-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 66071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty