Sean Patrick Goolsby, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D13152 Issued in MN

Practice address

12745 N 1St Ave
Lindstrom, MN 55045-9585

Phone

(651) 257-2720

NPI assigned

May 17, 2011

Last updated

Dec 9, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Borealis Dental Wyoming PA

  • General Practice Dentistry
  • Wyoming, MN
  • NPI 1750147492
  NPD Authorized official
• Borealis Dental Studio, P.a.

  • Dentist
  • Lindstrom, MN
  • NPI 1922450634
  NPD (past)
• Modern Dental Professionals Minnesota PC

  dba Midwest Dental - Chisago City

  • General Practice Dentistry
  • Chisago City, MN
  • NPI 1043589484
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575849600000",
    "number": "1558654012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "550450399",
            "telephone_number": "651-257-2720",
            "fax_number": "651-257-8752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12745 N 1ST AVE",
            "city": "LINDSTROM",
            "state": "MN",
            "postal_code": "550459585",
            "telephone_number": "651-257-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOOLSBY",
        "first_name": "SEAN",
        "middle_name": "PATRICK",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-17",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D13152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erik J. Peterson Chiropractic, LLC (Lakes Area Chiropractic Clinic)
• Four Winds Center for Wellness Inc
• Deboorah A Gibson
• Teddy Ray Gildersleeve
• Lukas Gillett, DDS
• Eric Jon Gormanson, D.C.
• Shawna Jo Griffin, FNP
• Kelly Marie Helland, LICSW
• Regina Hollibush, LCSW
• Michael A Hursh, DDS

• General Practice Dentistry in Lindstrom, MN
• Providers in Lindstrom, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.