Healthcare Provider Details

I. General information

NPI: 1427505056
Provider Name (Legal Business Name): ZACHARY GOETTSCHE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E 57TH ST
SIOUX FALLS SD
57108-8614
US

IV. Provider business mailing address

4824 E 57TH ST
SIOUX FALLS SD
57108-8614
US

V. Phone/Fax

Practice location:
  • Phone: 605-961-9092
  • Fax: 605-961-9093
Mailing address:
  • Phone: 605-961-9092
  • Fax: 605-961-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberRES-30483
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD1300
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: