Healthcare Provider Details

I. General information

NPI: 1750507414
Provider Name (Legal Business Name): ADENA MICHELLE GOLDMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 FOREST AVE STE K
PARAMUS NJ
07652-5424
US

IV. Provider business mailing address

76 HALLBERG AVE
BERGENFIELD NJ
07621-2618
US

V. Phone/Fax

Practice location:
  • Phone: 201-523-6298
  • Fax: 201-967-5559
Mailing address:
  • Phone: 201-385-5953
  • Fax: 201-385-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI21491
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: