Healthcare Provider Details

I. General information

NPI: 1962694000
Provider Name (Legal Business Name): ROBERT S. GOLDIE, DMD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 09/17/2009
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:
Mailing address:
  • Phone: 407-363-4800
  • Fax:

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: DR. ROBERT GOLDIE
Title or Position: PRESIDENT
Credential:
Phone: 407-363-4800