Provider Demographics
NPI:1952615759
Name:GOIST, JULIE A (DDS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:GOIST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:5861 MASON DIXON HIGHWAY
Mailing Address - City:BLACKSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26521-0072
Mailing Address - Country:US
Mailing Address - Phone:304-432-8211
Mailing Address - Fax:
Practice Address - Street 1:5861 MASON DIXON HIGHWAY
Practice Address - Street 2:
Practice Address - City:BLACKSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26521
Practice Address - Country:US
Practice Address - Phone:304-432-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist