Provider Demographics
NPI:1952979346
Name:GOETZ, ANNA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LYNN
Last Name:GOETZ
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 1:244 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1256
Mailing Address - Country:US
Mailing Address - Phone:715-762-2188
Mailing Address - Fax:
Practice Address - Street 1:244 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1256
Practice Address - Country:US
Practice Address - Phone:715-762-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002565-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist