Individual provider Active NPI

Maryna Michelle Goergy, D.D.S.

  • General Practice Dentistry
  • Denver, CO
National Provider Identifier
1750721791
Registry record updated Jul 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.023980 Issued in OH
Practice address
1055 Clermont St
160
Denver, CO 80220-3808
Phone
(303) 399-8020
NPI assigned
Jul 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30.023980 OH Primary

Addresses

Primary practice location

1055 Clermont St
160
Denver, CO 80220-3808

Mailing address

1 S Washington St Apt 301
Denver, CO 80209-2050
Phone (440) 590-3752

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20231002001722 OH Order and Referring Only - DentistPractitioner - Dentist 3870891104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30.023980OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Goergy RFD LLC Current Accepting new patients
Broadlands Family Dentistry General Partnership Past Accepting new patients

Locations

4322 S Cleveland Massillon Rd
Ste A
Norton, OH 44203
Phone (330) 825-7602

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.

NPI Registry JSON

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

{
    "created_epoch": "1372809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372809600000",
    "number": "1750721791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S WASHINGTON ST APT 301",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802092050",
            "telephone_number": "440-590-3752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 CLERMONT ST",
            "address_2": "160",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802203808",
            "telephone_number": "303-399-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOERGY",
        "first_name": "MARYNA",
        "middle_name": "MICHELLE",
        "name_prefix": "Miss",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-03",
        "last_updated": "2013-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.023980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.