Provider Demographics
NPI:1538381702
Name:GOLDMAN, ELIZABETH S (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:S
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 REDBUD BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3226
Mailing Address - Country:US
Mailing Address - Phone:214-585-0268
Mailing Address - Fax:214-585-0284
Practice Address - Street 1:1575 REDBUD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3226
Practice Address - Country:US
Practice Address - Phone:214-585-0268
Practice Address - Fax:214-585-0284
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164662204Medicaid
TX321258102Medicaid
TX16466203Medicaid
TX164662201Medicaid
TX321258101Medicaid
TX16962OtherCHIP NUMBER