Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 39 | OK |
NPI | 1104927359 |
---|---|
Provider Name | Dr. Andrew Paul Goldbeck |
First Address | Edmond, OK 73034-7342 |
Second Address | Oklahoma City, OK 73117-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 24/07/2019 |