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General NPI Number Information
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NPI Number | 1669799714
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Entity Type | Organization
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Legal Business Name | WEST SIDE KIDS DENTAL, PC
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 04/29/2010
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Provider Practice Location Address
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Address Line | 107 W 86TH ST 1 B
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City | NEW YORK
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State | NY
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Zip | 10024-3409
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Country | US
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Telephone | 212-877-2163
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Fax | 212-877-2133
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Provider Business Mailing Address
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Address Line | 107 W 86TH ST 1 B
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City | NEW YORK
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State | NY
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Zip | 10024-3409
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Country | US
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Telephone | 212-877-2163
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Fax | 212-877-2133
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT NEAL GOLDSMITH
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Credential | DMD
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Telephone | 212-877-2163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 052974-1
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License Number State | NY
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