Provider Demographics
NPI:1932367943
Name:JEFFREY A GOLDMAN,D.D.S,LLC
Entity Type:Organization
Organization Name:JEFFREY A GOLDMAN,D.D.S,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANZALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-242-0663
Mailing Address - Street 1:1 THOMPSON SQ
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3328
Mailing Address - Country:US
Mailing Address - Phone:617-242-0663
Mailing Address - Fax:617-242-8539
Practice Address - Street 1:1 THOMPSON SQ
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3328
Practice Address - Country:US
Practice Address - Phone:617-242-0663
Practice Address - Fax:617-242-8539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty