Provider Demographics
NPI:1568499218
Name:GOLDMAN, JONATHAN F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3080
Mailing Address - Country:US
Mailing Address - Phone:860-242-6142
Mailing Address - Fax:860-243-5211
Practice Address - Street 1:701 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3080
Practice Address - Country:US
Practice Address - Phone:860-242-6142
Practice Address - Fax:860-243-5211
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT72111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT190000684OtherPTAN
CT83982OtherAETNA
CT020007211CT03OtherBLUE CROSS BLUE SHIELD
CT0146671004OtherCIGNA
CT4227283OtherAETNA
CT020007211CT04OtherBLUE CROSS BLUE SHIELD
CT750677OtherCONNECTICARE
CT0146671003OtherCIGNA
CTP1274198OtherOXFORD
CT020007211CT03OtherBLUE CROSS BLUE SHIELD
CT0146671003OtherCIGNA