Provider Demographics
NPI:1841290269
Name:GOLDFEDER, RICHARD M (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:GOLDFEDER
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 1:1480 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1750
Mailing Address - Country:US
Mailing Address - Phone:860-388-3110
Mailing Address - Fax:860-388-3113
Practice Address - Street 1:1480 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1750
Practice Address - Country:US
Practice Address - Phone:860-388-3110
Practice Address - Fax:860-388-3113
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT72751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice