Provider Demographics
NPI:1336273846
Name:GOLTZ, LINDA GAIL (DDS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GAIL
Last Name:GOLTZ
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 1:800 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3355
Mailing Address - Country:US
Mailing Address - Phone:989-686-7174
Mailing Address - Fax:989-686-1860
Practice Address - Street 1:800 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-3355
Practice Address - Country:US
Practice Address - Phone:989-686-7174
Practice Address - Fax:989-686-1860
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI132821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice