Roland Elwyn Goertzen, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

MT1681 Issued in MT

Practice address

1608 Main Street East
Thompson Falls, MT 59873

Phone

(406) 827-4681

Fax

(406) 827-4781

NPI assigned

Aug 4, 2006

Last updated

Jul 8, 2007By 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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• River Town Dental Corporation

  • Dentist
  • Thompson Falls, MT
  • NPI 1235722737
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740298736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 LITTLE BEAVER CREEK ROAD",
            "city": "TROUT CREEK",
            "state": "MT",
            "postal_code": "59874",
            "telephone_number": "406-827-3531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 MAIN STREET EAST",
            "city": "THOMPSON FALLS",
            "state": "MT",
            "postal_code": "59873",
            "telephone_number": "406-827-4681",
            "fax_number": "406-827-4781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOERTZEN",
        "first_name": "ROLAND",
        "middle_name": "ELWYN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MT",
            "license": "MT1681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0111027",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kurtis Hunt Fairbank, LAC
• Steven Fairbank, LAC, NCAC II
• Full Spectrum Psychotherapy Inc
• Gateway Community Services (Gateway Community Services-Thompson Falls)
• Gateway Community Services (Gateway Community Services-Thompson Falls)
• Alan Gravning, RPH
• Frances Elizabeth Gryl, ED.S., LCPC
• Sarah Harmon, PT, DPT
• Abigail Harnett, LCSW, CMHP
• Hayley Allen-Blakney, LCSW, PLLC

• General Practice Dentistry in Thompson Falls, MT
• Providers in Thompson Falls, MT by specialty
• General Practice Dentistry in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.