Provider Demographics
NPI:1063569556
Name:GOLDRICH, ERWIN HILLARD (DMD)
Entity type:Individual
Prefix:DR
First Name:ERWIN
Middle Name:HILLARD
Last Name:GOLDRICH
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 1:464 SAW CREEK EST
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-9425
Mailing Address - Country:US
Mailing Address - Phone:570-588-7096
Mailing Address - Fax:609-562-6851
Practice Address - Street 1:5660 DOUGHBOY AVE
Practice Address - Street 2:
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640
Practice Address - Country:US
Practice Address - Phone:609-562-2610
Practice Address - Fax:609-562-6851
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0285361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice