Healthcare Provider Details

I. General information

NPI: 1528822541
Provider Name (Legal Business Name): LAKSHAY GOYAL DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W OAKLAND PARK BLVD STE B21
OAKLAND PARK FL
33311-1239
US

IV. Provider business mailing address

2901 W OAKLAND PARK BLVD STE B21
OAKLAND PARK FL
33311-1239
US

V. Phone/Fax

Practice location:
  • Phone: 954-816-0555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LAKSHAY GOYAL
Title or Position: OWNER
Credential:
Phone: 954-816-0555