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General NPI Number Information
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NPI Number | 1326677204
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Entity Type | Individual
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Provider Name | BENJAMIN DYLAN GOLUB
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Gender | Male
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 50 BLUEBERRY DR
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677-8106
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Country | US
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Telephone | 201-543-9741
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Fax |
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Provider Business Mailing Address
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Address Line | 50 BLUEBERRY DRIVE
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City | WOODCLIFF LAKE
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State | NJ
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Zip | 07677
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DIO2894101
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DIO2894100
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License Number State | NJ
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