=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831738632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT GOLIGHTLY DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2019
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3712 90TH ST APT 1
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-429-5550
-----------------------------------------------------
Fax | 718-429-5556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3712 90TH ST APT 1
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7862
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-429-5550
-----------------------------------------------------
Fax | 718-429-5556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. ROBERT GOLIGHTLY JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 917-659-9575
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------