Provider Demographics
NPI:1427128420
Name:GOSCH, KENDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:GOSCH
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 1:9840 S 168TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1102
Mailing Address - Country:US
Mailing Address - Phone:402-884-2400
Mailing Address - Fax:
Practice Address - Street 1:9840 S 168TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1102
Practice Address - Country:US
Practice Address - Phone:402-884-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice