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General NPI Number Information
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NPI Number | 1245450113
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Entity Type | Individual
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Provider Name | SCOTT D GOLDMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 1526 W GLENDALE AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85021-8576
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Country | US
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Telephone | 602-864-1080
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Fax |
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Provider Business Mailing Address
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Address Line | 1526 W GLENDALE AVE STE 103
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City | PHOENIX
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State | AZ
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Zip | 85021-8576
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Country | US
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Telephone | 312-882-2569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D010874
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License Number State | AZ
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