Provider Demographics
NPI:1881753788
Name:GOLDSMITH, DOUGLAS HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HOWARD
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 1:495 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1068
Mailing Address - Country:US
Mailing Address - Phone:914-472-0100
Mailing Address - Fax:914-472-1563
Practice Address - Street 1:495 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1068
Practice Address - Country:US
Practice Address - Phone:914-472-0100
Practice Address - Fax:914-472-1563
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD7B241Medicare ID - Type Unspecified
NYT50042Medicare UPIN
NYD7B241Medicare Oscar/Certification