Provider Demographics
NPI:1235021122
Name:GOETTSCHE, BRIANNE ELIZABETH (RDH)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:GOETTSCHE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 E CALDERWOOD DR # 110
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7440
Mailing Address - Country:US
Mailing Address - Phone:208-501-8860
Mailing Address - Fax:208-501-8862
Practice Address - Street 1:53 E CALDERWOOD DR # 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7440
Practice Address - Country:US
Practice Address - Phone:208-501-8860
Practice Address - Fax:208-501-8862
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2471866124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist