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General NPI Number Information
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NPI Number | 1649323031
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Entity Type | Organization
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Legal Business Name | MAURICE GOLBERG, ALAN MINTZ, LARRY DOVER DDS, PC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 119 W 57TH ST SUITE 415
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City | NEW YORK
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State | NY
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Zip | 10019-2303
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Country | US
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Telephone | 212-757-1457
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Fax | 212-757-9209
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Provider Business Mailing Address
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Address Line | 119 W 57TH ST SUITE 415
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City | NEW YORK
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State | NY
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Zip | 10019-2303
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Country | US
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Telephone | 212-757-1457
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Fax | 212-757-9209
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Authorized Official
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Title or Position | DR
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Name | LARRY DOBER
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Credential | D.M.D.
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Telephone | 212-757-1457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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