=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588873368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT S. GOLD DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 ROUTE 206 BUILDING #1, SUITE #6
-----------------------------------------------------
City | FLANDERS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-598-8423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 ROUTE 206 PO BOX 35
-----------------------------------------------------
City | FLANDERS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-598-8423
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CORPORATE PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT STUART GOLD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 973-598-8423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0106X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------