Provider Demographics
NPI:1336876549
Name:GOSS, DEANNA MARIE (RDH LAP)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:GOSS
Suffix:
Gender:F
Credentials:RDH LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 34TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-4216
Mailing Address - Country:US
Mailing Address - Phone:406-788-1979
Mailing Address - Fax:
Practice Address - Street 1:1801 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5608
Practice Address - Country:US
Practice Address - Phone:406-771-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1206124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty