=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487893780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN DENTAL CARE P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2009
-----------------------------------------------------
Last Update Date | 10/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5420 31ST AVE
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-659-9222
-----------------------------------------------------
Fax | 718-433-9106
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5420 31ST AVE
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-433-9126
-----------------------------------------------------
Fax | 718-433-9106
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DDS
-----------------------------------------------------
Name | MARINA U SHIMUNY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-433-9126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------