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NPI Code Detail

MEDICARE: DR. CODY SCOTT GOSLINGA D.M.D.

MEDICARE:  DR. CODY SCOTT GOSLINGA  D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN17072FL

General Provider Information

NPI Number : 1063422111
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CODY SCOTT GOSLINGA D.M.D.
Provider Business Mailing Address
First Line : 2441 WINCHESTER LN
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32092-1088
Country : US
Telephone Number : 904-230-1940
Fax Number :
Provider Business Practice Location Address
First Line : 2520 US ONE SOUTH
Second Line :
City : ST. AUGUSTINE
State : FL
Zip : 32086
Country : US
Telephone Number : 904-797-4833
Fax Number : 904-797-7128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/08/2007

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Directions to “ DR. CODY SCOTT GOSLINGA D.M.D.” Practice Location

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