MEDICARE: DR. TANNISHIA MARIE GOGGANS 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	30023330	OH

General Provider Information

NPI Number	:	1891016069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANNISHIA MARIE GOGGANS D.M.D

Provider Business Mailing Address
First Line	:	14209 REDDINGTON AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3209
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8210 MACEDONIA COMMONS BLVD
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1860
Country	:	US
Telephone Number	:	330-467-3500
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	03/24/2021

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