Healthcare Provider Details

I. General information

NPI: 1629356365
Provider Name (Legal Business Name): NICHOLAS EVAN GOETZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SE 27TH AVE
BOYNTON BEACH FL
33435-7632
US

IV. Provider business mailing address

101 SE 27TH AVE
BOYNTON BEACH FL
33435-7632
US

V. Phone/Fax

Practice location:
  • Phone: 561-265-1998
  • Fax: 561-265-3494
Mailing address:
  • Phone: 352-273-6901
  • Fax: 352-846-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 19346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: