MEDICARE: DR. VIKAS GOEL D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	010332	CT
2	122300000X	Dentist	055018	NY

General Provider Information

NPI Number	:	1114233848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKAS GOEL D.D.S

Provider Business Mailing Address
First Line	:	4700 ONONDAGA BLVD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13219-3316
Country	:	US
Telephone Number	:	315-442-7779
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 ONONDAGA BLVD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13219-3316
Country	:	US
Telephone Number	:	315-442-7779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	12/12/2013

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