Provider Demographics
NPI:1265656284
Name:GOLDMAN, ANDREW ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROGER
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 1:1550 RT 12
Mailing Address - Street 2:P.O. BOX 384
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335
Mailing Address - Country:US
Mailing Address - Phone:860-464-0166
Mailing Address - Fax:860-464-2886
Practice Address - Street 1:1550 RT 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335
Practice Address - Country:US
Practice Address - Phone:860-464-0166
Practice Address - Fax:860-464-2886
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT45391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice