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General NPI Number Information
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NPI Number | 1184907719
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Entity Type | Organization
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Legal Business Name | GOLDEN SLUMBER DENTAL PC
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 550 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-7369
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Country | US
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Telephone | 212-826-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 550 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-7369
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Country | US
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Telephone | 212-826-0777
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. BARRY ZANE
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Credential |
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Telephone | 212-826-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 34318
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License Number State | NY
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