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General NPI Number Information
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NPI Number | 1255461760
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Entity Type | Organization
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Legal Business Name | GOLDMAN & PACKMAN
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7600 RITCHIE HWY
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3718
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Country | US
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Telephone | 410-761-3335
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Fax | 410-761-3362
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Provider Business Mailing Address
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Address Line | 1205 DAIRY RD
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City | PARKTON
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State | MD
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Zip | 21120-9505
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Country | US
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Telephone | 410-329-6374
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. STEPHEN A GOLDMAN
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Credential | D.D.S.
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Telephone | 410-761-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4467
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License Number State | MD
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