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General NPI Number Information
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NPI Number | 1871713610
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Entity Type | Individual
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Provider Name | BENJAMIN GODDER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 E 57TH ST SUITE 1520
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City | NEW YORK
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State | NY
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Zip | 10022-2049
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Country | US
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Telephone | 212-750-3478
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Fax | 212-750-8929
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Provider Business Mailing Address
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Address Line | 100 BLEECKER ST APT.#5E
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City | NEW YORK
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State | NY
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Zip | 10012-2202
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Country | US
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Telephone | 212-750-3478
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Fax | 212-750-8929
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 040786-1
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License Number State | NY
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