Provider Demographics
NPI:1487698130
Name:GOSLIN, RYAN D (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:GOSLIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CLARKE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3754
Mailing Address - Country:US
Mailing Address - Phone:802-658-4777
Mailing Address - Fax:802-658-4809
Practice Address - Street 1:48 CLARKE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3754
Practice Address - Country:US
Practice Address - Phone:802-658-4777
Practice Address - Fax:802-658-4809
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01621551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011744Medicaid