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General NPI Number Information
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NPI Number | 1376892018
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Entity Type | Organization
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Legal Business Name | DR. LEONARD GOLDMAN, PA
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 09/07/2012
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Provider Practice Location Address
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Address Line | 12510 PROSPERITY DR SUITE 250
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City | SILVER SPRING
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State | MD
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Zip | 20904-1663
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Country | US
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Telephone | 301-622-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 12510 PROSPERITY DR SUITE 250
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City | SILVER SPRING
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State | MD
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Zip | 20904-1663
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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. LEONARD JAY GOLDMAN
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Credential | D.D.S.
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Telephone | 301-622-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 8392
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License Number State | MD
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