Healthcare Provider Details

I. General information

NPI: 1699765370
Provider Name (Legal Business Name): ROBERT T. GOLD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 KING ST
CROTON ON HUDSON NY
10520-2115
US

IV. Provider business mailing address

25 KING ST
CROTON ON HUDSON NY
10520-2115
US

V. Phone/Fax

Practice location:
  • Phone: 914-393-0295
  • Fax:
Mailing address:
  • Phone: 914-271-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: