Individual
DR. LEONID GOFMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
10890 BUSTLETON AVE, SUITE 107, PHILADELPHIA, PA 19116-3313
(215) 677-9910
Mailing address
10890 BUSTLETON AVE, SUITE 107, PHILADELPHIA, PA 19116-3313
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS028692L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001429794
—
PA
Enumeration date
07/26/2006
Last updated
07/08/2007
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