=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821254111
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REENA GOYAL DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2008
-----------------------------------------------------
Last Update Date | 04/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 CALEB LN
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-6136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-549-3342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 CALEB LN
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-6136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-549-3342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS037602
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------