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General NPI Number Information
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NPI Number | 1235433012
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Entity Type | Organization
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Legal Business Name | SCOTT D. GOLDMAN, DDS, PC
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 2050 LARKIN AVE SUITE 100
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City | ELGIN
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State | IL
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Zip | 60123-4405
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Country | US
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Telephone | 847-987-0322
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 LARKIN AVE SUITE 100
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City | ELGIN
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State | IL
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Zip | 60123-4405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT D. GOLDMAN
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Credential | DDS
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Telephone | 847-987-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021002316
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License Number State | IL
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