Individual
DR. MARVIN J GOTTSCHALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1821 N LECLERC RD. #1, CUSICK, WA 99119-5015
(509) 447-7111
(509) 445-1152
Mailing address
1821 N LECLERC RD. #1, CUSICK, WA 99119-5015
(509) 447-7111
(509) 445-1152
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00009801
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213060
LABOR & INDUSTRIES ID #
WA
05
—
5051537
—
WA
Enumeration date
02/14/2007
Last updated
06/03/2011
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