MEDICARE: DAVID GOTTESFELD, DDS PC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	27531	NY

General Provider Information

NPI Number	:	1932438926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID GOTTESFELD, DDS PC

Provider Business Mailing Address
First Line	:	1757 MERRICK AVE
Second Line	:	SUITE 101
City	:	MERRICK
State	:	NY
Zip	:	11566-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 MERRICK AVE
Second Line	:	SUITE 101
City	:	MERRICK
State	:	NY
Zip	:	11566-2717
Country	:	US
Telephone Number	:	516-623-1617
Fax Number	:	516-623-7825

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID GOTTESFELD
Credential	:	DDS MSD
Telephone Number	:	516-623-1617

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	12/22/2009

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