Healthcare Provider Details

I. General information

NPI: 1275594509
Provider Name (Legal Business Name): DONALD LANCE GOSSETT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 FREDERICK AVE SUITE A
SAINT JOSEPH MO
64506-2911
US

IV. Provider business mailing address

1 HUNDLEY DR
SAINT JOSEPH MO
64506-2118
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-2300
  • Fax:
Mailing address:
  • Phone: 816-279-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number013475
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: