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General NPI Number Information
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NPI Number | 1366454852
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Entity Type | Organization
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Legal Business Name | FINE & GOODMAN DDS
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12301 82ND RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1601
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Country | US
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Telephone | 718-261-6303
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Fax | 718-261-0307
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Provider Business Mailing Address
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Address Line | 12301 82ND RD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1601
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Country | US
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Telephone | 718-261-6303
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Fax | 718-261-0307
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JAY GOODMAN
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Credential | DDS
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Telephone | 718-261-6303
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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 | 031052
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License Number State | NY
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