MEDICARE: DR. SCOTT D GOLDMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	021002316	IL
2	1223P0221X	Pediatric Dentistry	D010874	AZ

General Provider Information

NPI Number	:	1245450113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT D GOLDMAN DDS

Provider Business Mailing Address
First Line	:	1526 W GLENDALE AVE STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	312-882-2569
Fax Number	:

Provider Business Practice Location Address
First Line	:	1526 W GLENDALE AVE STE 103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8576
Country	:	US
Telephone Number	:	602-864-1080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	02/20/2025

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Directions to “ DR. SCOTT D GOLDMAN DDS” Practice Location

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