Provider Demographics
NPI:1144230434
Name:GOLDSAMT, BRADLEY D (DDS)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:GOLDSAMT
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 1:650 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516
Mailing Address - Country:US
Mailing Address - Phone:316-295-1255
Mailing Address - Fax:316-295-3461
Practice Address - Street 1:650 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516
Practice Address - Country:US
Practice Address - Phone:316-295-1255
Practice Address - Fax:316-295-3461
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0429441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics