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NPI Code Detail

MEDICARE: DR. NICHOLAS EVAN GOETZ D.M.D.

MEDICARE: DR. NICHOLAS EVAN GOETZ 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
11223P0700XProsthodonticsDN 19346FL

General Provider Information

NPI Number : 1629356365
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS EVAN GOETZ D.M.D.
Provider Business Mailing Address
First Line : 101 SE 27TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-7632
Country : US
Telephone Number : 352-273-6901
Fax Number : 352-846-0248
Provider Business Practice Location Address
First Line : 101 SE 27TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-7632
Country : US
Telephone Number : 561-265-1998
Fax Number : 561-265-3494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2011
Last Update Date : 05/14/2026

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