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General NPI Number Information
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NPI Number | 1063539765
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Entity Type | Individual
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Provider Name | MATTHEW TIMOTHY GOSLEE DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 255 NORTH MAIN ST. C/O DR. MATT GOSLEE POSNER AND TURKUS DDS
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City | BRISTOL
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State | CT
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Zip | 06010
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Country | US
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Telephone | 860-589-7170
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SQUIRREL HILL LN
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1035
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Country | US
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Telephone | 860-214-9745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 009536
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License Number State | CT
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