Healthcare Provider Details

I. General information

NPI: 1407505787
Provider Name (Legal Business Name): CHRISTINA LYNN GOSS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MAIN ST
ASBURY PARK NJ
07712-5359
US

IV. Provider business mailing address

9 COAST DR
BRICK NJ
08723-7412
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-6333
  • Fax:
Mailing address:
  • Phone: 973-710-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number22HI01077500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: