Healthcare Provider Details

I. General information

NPI: 1932278629
Provider Name (Legal Business Name): BARRY MORTON GOLDMAN DDS. MS.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

108 YUCCA AVE
NORTH AUGUSTA SC
29860-9229
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2371
  • Fax:
Mailing address:
  • Phone: 803-634-7180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE60399541
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN006851
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number051185
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number61328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: