1003924622 NPI number — DR. MATTHEW J GOLDSCHMIDT MD, DMD, FACS

Table of content: DR. MATTHEW J GOLDSCHMIDT MD, DMD, FACS (NPI 1003924622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003924622 NPI number — DR. MATTHEW J GOLDSCHMIDT MD, DMD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSCHMIDT
Provider First Name:
MATTHEW
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, DMD, FACS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOLDSCHMIDT
Provider Other First Name:
MATTHEW
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, DMD, FACS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003924622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 NOB HILL OVAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAGRIN FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-410-0618
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 ROCKSIDE RD
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44131-2194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-264-8100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  35-083072 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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