Healthcare Provider Details

I. General information

NPI: 1982785564
Provider Name (Legal Business Name): AVIJIT GOEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PENNSYLVANIA AVE SUITE 206
WILMINGTON DE
19806-4124
US

IV. Provider business mailing address

3310 BREIDABLIK DR
GREENVILLE DE
19807-1925
US

V. Phone/Fax

Practice location:
  • Phone: 914-420-2053
  • Fax:
Mailing address:
  • Phone: 914-420-2053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS036689
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-09066
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number09066
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberG1-0001283
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberG1-0001283
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036689
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: