Healthcare Provider Details

I. General information

NPI: 1326277047
Provider Name (Legal Business Name): BATYA R GOLDWASER DMD, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 NW 5TH ST STE 105
PLANTATION FL
33317-1612
US

IV. Provider business mailing address

7500 NW 5TH ST STE 105
PLANTATION FL
33317-1612
US

V. Phone/Fax

Practice location:
  • Phone: 954-792-5544
  • Fax:
Mailing address:
  • Phone: 954-792-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN23768
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number057880-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: