Provider Demographics
NPI:1114168580
Name:GOLDMAN, ALAN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RICHARD
Last Name:GOLDMAN
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 1:205 W RANDOLPH ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1867
Mailing Address - Country:US
Mailing Address - Phone:312-920-0505
Mailing Address - Fax:312-920-9020
Practice Address - Street 1:205 W RANDOLPH ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1867
Practice Address - Country:US
Practice Address - Phone:312-920-0505
Practice Address - Fax:312-920-9020
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-13515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist