Healthcare Provider Details

I. General information

NPI: 1477526218
Provider Name (Legal Business Name): JULIANE GOLDEN-WOLOVNICK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E MOSHOLU PKWY N
BRONX NY
10467-2625
US

IV. Provider business mailing address

55 E MOSHOLU PKWY N
BRONX NY
10467-2625
US

V. Phone/Fax

Practice location:
  • Phone: 718-652-7370
  • Fax: 718-882-5650
Mailing address:
  • Phone: 718-652-7370
  • Fax: 718-882-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number35889
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: