Healthcare Provider Details

I. General information

NPI: 1518974989
Provider Name (Legal Business Name): ROBERT GOLDIE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 DR PHILLIPS BLVD SUITE 9
ORLANDO FL
32819-5140
US

IV. Provider business mailing address

7051 DR PHILLIPS BLVD SUITE 9
ORLANDO FL
32819-5140
US

V. Phone/Fax

Practice location:
  • Phone: 407-363-4800
  • Fax: 407-363-7003
Mailing address:
  • Phone: 407-363-4800
  • Fax: 407-363-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: