Provider Demographics
NPI:1427197334
Name:GOLDSMITH, JERROLD KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:KENT
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 1:141 NORTH SHORTRIDGE RD
Mailing Address - Street 2:B5
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219
Mailing Address - Country:US
Mailing Address - Phone:317-357-4018
Mailing Address - Fax:317-356-4600
Practice Address - Street 1:141 NORTH SHORTRIDGE RD
Practice Address - Street 2:B5
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219
Practice Address - Country:US
Practice Address - Phone:317-357-4018
Practice Address - Fax:317-356-4600
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12004356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist