Provider Demographics
NPI:1336599935
Name:GOETSCH, BRANDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:
Last Name:GOETSCH
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 1:1720 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-7701
Mailing Address - Country:US
Mailing Address - Phone:920-235-3251
Mailing Address - Fax:
Practice Address - Street 1:229 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5434
Practice Address - Country:US
Practice Address - Phone:920-733-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001333-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist