Provider Demographics
NPI:1083717037
Name:GOLDSMITH, BRYAN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:D
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:518 E. WHITEHOUSE CANYON ROAD
Mailing Address - Street 2:SUITE. 190
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614
Mailing Address - Country:US
Mailing Address - Phone:520-399-4100
Mailing Address - Fax:520-399-4103
Practice Address - Street 1:518 E WHITEHOUSE CANYON RD
Practice Address - Street 2:SUITE. 190
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0533
Practice Address - Country:US
Practice Address - Phone:520-399-4100
Practice Address - Fax:520-399-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice