Provider Demographics
NPI:1962694000
Name:ROBERT S. GOLDIE, DMD, P.A.
Entity type:Organization
Organization Name:ROBERT S. GOLDIE, DMD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-363-4800
Mailing Address - Street 1:7051 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5140
Mailing Address - Country:US
Mailing Address - Phone:407-363-4800
Mailing Address - Fax:
Practice Address - Street 1:7051 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5140
Practice Address - Country:US
Practice Address - Phone:407-363-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty