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 1:601 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 2ND AVE S STE 203
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1831
Practice Address - Country:US
Practice Address - Phone:406-791-9267
Practice Address - Fax:406-791-9277
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-RDH-LIC-1206124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty