Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 009536 | CT |
NPI | 1063539765 |
---|---|
Provider Name | Dr. Matthew Timothy Goslee |
First Address | West Hartford, CT 06107-1035 |
Second Address | Bristol, CT 06010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 25/02/2009 |