Healthcare Provider Details

I. General information

NPI: 1952390486
Provider Name (Legal Business Name): JAY GOLDSLEGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH RD SUITE 100
KING OF PRUSSIA PA
19406-3174
US

IV. Provider business mailing address

357 S GULPH RD
KING OF PRUSSIA PA
19406-3136
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-2325
  • Fax: 610-337-3863
Mailing address:
  • Phone: 610-337-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS018777L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: