Provider Demographics
NPI:1801638788
Name:GOLDSMITH, DANIEL PHILLIP (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PHILLIP
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 ORIOLE CT
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9340
Mailing Address - Country:US
Mailing Address - Phone:319-530-4627
Mailing Address - Fax:
Practice Address - Street 1:403 DEER VIEW AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-4725
Practice Address - Country:US
Practice Address - Phone:319-545-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist