Healthcare Provider Details

I. General information

NPI: 1316404387
Provider Name (Legal Business Name): ANITA LEORAH GOTZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 60TH ST FL 5
NEW YORK NY
10022-1117
US

IV. Provider business mailing address

118 E 60TH ST APT 19G
NEW YORK NY
10022-6643
US

V. Phone/Fax

Practice location:
  • Phone: 646-470-4120
  • Fax:
Mailing address:
  • Phone: 267-912-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number062695
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: