Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN16345 | FL |
NPI | 1063628253 |
---|---|
Provider Name | Dr. Greg Ross Goldfaden |
First Address | Aventura, FL 33180-2318 |
Second Address | Aventura, FL 33180-2318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |