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General NPI Number Information
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NPI Number | 1760890453
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Entity Type | Individual
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Provider Name | DUSTIN GOETZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2014
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Last Update Date | 07/26/2014
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Provider Practice Location Address
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Address Line | 201 N CONSTITUTION DR
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City | AURORA
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State | IL
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Zip | 60506-3200
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Country | US
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Telephone | 630-840-2640
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Fax |
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Provider Business Mailing Address
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Address Line | 25460 W SCOTT RD
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City | BARRINGTON
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State | IL
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Zip | 60010-2423
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Country | US
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Telephone | 847-254-3819
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029887
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License Number State | IL
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