Provider Demographics
NPI:1932399581
Name:GOSS, ERICA COE (DDS)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:COE
Last Name:GOSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:JEANNE
Other - Last Name:COE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2200 KELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309
Mailing Address - Country:US
Mailing Address - Phone:940-322-2252
Mailing Address - Fax:940-322-7090
Practice Address - Street 1:2200 KELL BLVD.
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309
Practice Address - Country:US
Practice Address - Phone:940-322-2252
Practice Address - Fax:940-322-7090
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice