MEDICARE: DR. LEONARD HARRY GOLDSMITH D.D.S.

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	1223G0001X	General Practice Dentistry	5903	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L970	OTHER	MD	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1801896964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD HARRY GOLDSMITH D.D.S.

Provider Business Mailing Address
First Line	:	5 RUNNING BROOK CT
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-1637
Country	:	US
Telephone Number	:	410-561-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1119 MERRITT BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-1438
Country	:	US
Telephone Number	:	410-284-9400
Fax Number	:

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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