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General NPI Number Information
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NPI Number | 1326162587
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Entity Type | Organization
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Legal Business Name | EAST SAFFOLK DENTAL PC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1149 OLD COUNTRY ROAD
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-369-7400
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Fax | 631-369-4214
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Provider Business Mailing Address
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Address Line | 400 WEST MAIN STREET SUITE 211
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City | BABYLON
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State | NY
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Zip | 11702
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Country | US
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Telephone | 631-422-6066
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Fax | 631-422-6366
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Authorized Official
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Title or Position | PRES
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Name | STEVEN M GOLDBERG
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Credential | DDS
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Telephone | 631-369-7400
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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 | 0318241
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License Number State | NY
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