Healthcare Provider Details

I. General information

NPI: 1497826119
Provider Name (Legal Business Name): BRUCE GOLDIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 RIDGE RD W
ROCHESTER NY
14615-2405
US

IV. Provider business mailing address

172 FAIR OAKS AVE
ROCHESTER NY
14618-1829
US

V. Phone/Fax

Practice location:
  • Phone: 585-865-6691
  • Fax:
Mailing address:
  • Phone: 585-473-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: