Andrew Roger Goldman, D.D.S.
Individual provider Active NPI General Practice Dentistry · Gales Ferry, CT
NPI 1265656284 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1265656284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4539 (CT)
- Practice address
- 1550 RT 12
Gales Ferry, CT 06335 - Phone
- (860) 464-0166
- Fax
- (860) 464-2886
- NPI assigned
- Apr 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160429001610 | CT | Order and Referring Only - Dentist |
2668771304 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4539 | CT | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4539 | CT | Yes |
Addresses
Primary practice location
1550 RT 12
Gales Ferry, CT 06335
Mailing address
1550 RT 12
P.O. Box 384
Gales Ferry, CT 06335
Phone (860) 464-0166
Other providers in Gales Ferry, CT
- Marjorie Foxon
- Gales Ferry Medical Group LLC
- Gales Ferry Orthodontics LLC
- Gales Ferry Pediatric Group
- Mary Gilbert
- Sanford Alan Greenhouse
- Randall D. Harris
- Marie Antointeet Healy
- John Joseph Hennessey
- Holistic Mental Wellness Therapy
All providers in Gales Ferry, CT · General Practice Dentistry in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.