Provider Demographics
NPI:1962828459
Name:GOLDSCHMIDT, EUGENE ALBERT I
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ALBERT
Last Name:GOLDSCHMIDT
Suffix:I
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:ALBERT
Other - Last Name:GOLDSCHMIDT
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:236 S HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3118
Mailing Address - Country:US
Mailing Address - Phone:805-498-1495
Mailing Address - Fax:805-489-0556
Practice Address - Street 1:236 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3118
Practice Address - Country:US
Practice Address - Phone:805-498-1495
Practice Address - Fax:805-489-0556
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist