Provider Demographics
NPI:1023700739
Name:GOELZ, JENNY (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNY
Middle Name:
Last Name:GOELZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:BRINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:304 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1349
Mailing Address - Country:US
Mailing Address - Phone:320-352-2822
Mailing Address - Fax:
Practice Address - Street 1:304 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1349
Practice Address - Country:US
Practice Address - Phone:320-352-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist