MEDICARE: MRS. SHELLI MARGARET GOSS

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
1	124Q00000X	Dental Hygienist	DH0000005767	TN

General Provider Information

NPI Number	:	1821173105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLI MARGARET GOSS

Provider Business Mailing Address
First Line	:	104 COOLMORE CT
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-2850
Country	:	US
Telephone Number	:	615-566-9916
Fax Number	:

Provider Business Practice Location Address
First Line	:	5073 COLUMBIA PIKE
Second Line	:	SUITE 240
City	:	SPRING HILL
State	:	TN
Zip	:	37174-8607
Country	:	US
Telephone Number	:	615-302-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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