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General NPI Number Information
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NPI Number | 1639623382
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Entity Type | Individual
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Provider Name | YVONNE C GOLDMAN RDH
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Gender | Female
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 1 BAY AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4837
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Country | US
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Telephone | 973-429-6892
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Fax | 973-680-7809
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Provider Business Mailing Address
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Address Line | 295 LUPINE WAY
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City | SHORT HILLS
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State | NJ
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Zip | 07078-2314
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Country | US
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Telephone | 973-376-2983
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Fax | 973-680-7809
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 22HI00340500
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License Number State | NJ
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