Provider Demographics
NPI:1144398298
Name:GOLDMAN, MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:6 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 6C
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5601
Mailing Address - Country:US
Mailing Address - Phone:518-348-0240
Mailing Address - Fax:518-348-0248
Practice Address - Street 1:1201 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1028
Practice Address - Country:US
Practice Address - Phone:518-785-3084
Practice Address - Fax:518-785-0243
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-07-13
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Provider Licenses
StateLicense IDTaxonomies
NY033758-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery