Gordon F Goettsch, DDS
Individual provider
Active NPI
Dentist · Manchester, IA
NPI 1487765822 · NPPES record last updated Jul 17, 2007
Key facts
- NPI
- 1487765822
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6119 (IA)
- Practice address
- 120 E Fayette St
Manchester, IA 52057-1705
- Phone
- (563) 927-4746
- Fax
- (563) 927-6217
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20141008001180 |
IA |
Order and Referring Only - Oral Surgery
Practitioner - Oral Surgery |
9234359571 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 6119 | IA | MD | Dentist |
| 06119 | IA | MD | Child & Adolescent Psychiatry Physician |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
6119 |
IA |
Yes |
Addresses
Primary practice location
120 E Fayette St
Manchester, IA 52057-1705
Mailing address
120 E Fayette St
Manchester, IA 52057-1705
Phone (563) 927-4746
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 1129577 | Medicaid | IA | |