MEDICARE: JENNIFER GOTCH DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8773	IA

General Provider Information

NPI Number	:	1528499068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER GOTCH DDS PC

Provider Business Mailing Address
First Line	:	PO BOX 176
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51102-0176
Country	:	US
Telephone Number	:	712-224-4001
Fax Number	:

Provider Business Practice Location Address
First Line	:	5708 SUNNYBROOK DR
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4249
Country	:	US
Telephone Number	:	712-224-4001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. JENNIFER GOTCH
Credential	:	D.D.S.
Telephone Number	:	712-224-4001

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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