Provider Demographics
NPI:1386901619
Name:GOLDMAN, RICHARD MEREDITH (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MEREDITH
Last Name:GOLDMAN
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:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-0518
Mailing Address - Country:US
Mailing Address - Phone:203-373-6854
Mailing Address - Fax:
Practice Address - Street 1:77 PATRICIA CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1186
Practice Address - Country:US
Practice Address - Phone:203-373-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice