Provider Demographics
NPI:1588969919
Name:GOLDMAN, MARTIN L (DDS)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
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 1:900 COLUSA AVE STE 205-A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2319
Mailing Address - Country:US
Mailing Address - Phone:510-527-6673
Mailing Address - Fax:510-868-6211
Practice Address - Street 1:900 COLUSA AVE STE 205-A
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2319
Practice Address - Country:US
Practice Address - Phone:510-527-6673
Practice Address - Fax:510-868-6211
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist