Healthcare Provider Details

I. General information

NPI: 1992787642
Provider Name (Legal Business Name): ADA GOLDSMITH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MORGANZA RD
CANONSBURG PA
15317-8547
US

IV. Provider business mailing address

330 MORGANZA RD
CANONSBURG PA
15317-8547
US

V. Phone/Fax

Practice location:
  • Phone: 724-916-0111
  • Fax: 724-916-0114
Mailing address:
  • Phone: 724-916-0111
  • Fax: 724-916-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS028576L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: