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General NPI Number Information
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NPI Number | 1669686150
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Entity Type | Organization
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Legal Business Name | MARSHALL R GOLDMAN DDSPA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11963 REISTERSTOWN RD
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3030
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Country | US
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Telephone | 410-833-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 2430 DIANA RD
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City | BALTIMORE
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State | MD
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Zip | 21209-1526
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Country | US
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Telephone | 410-486-2158
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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. MARSHALL ROBERT GOLDMAN
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Credential |
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Telephone | 410-486-2158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3686
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License Number State | MD
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