Provider Demographics
NPI:1083716179
Name:GOLDSMITH, MARC ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:ONE CLEVELAND PLACE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-0836
Mailing Address - Country:US
Mailing Address - Phone:973-376-4653
Mailing Address - Fax:973-376-1587
Practice Address - Street 1:1 CLEVELAND PLACE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-0836
Practice Address - Country:US
Practice Address - Phone:973-376-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ10939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist