Provider Demographics
NPI:1356543151
Name:GOLDMAN, WILLIAM B (DDS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 EAST 23 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210
Mailing Address - Country:US
Mailing Address - Phone:718-377-1944
Mailing Address - Fax:
Practice Address - Street 1:171 RAMAPO RD
Practice Address - Street 2:LOW TOR PROFESSIONAL CENTER ROUTE 202
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923
Practice Address - Country:US
Practice Address - Phone:845-947-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0363371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics