MEDICARE: PEDIATRIC DENTISTRY COMMUNITY DRIVE GREAT NECK PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1013871573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC DENTISTRY COMMUNITY DRIVE GREAT NECK PC

Provider Business Mailing Address
First Line	:	225 COMMUNITY DR STE 170
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5503
Country	:	US
Telephone Number	:	516-231-8480
Fax Number	:	516-231-9164

Provider Business Practice Location Address
First Line	:	225 COMMUNITY DR STE 170
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5503
Country	:	US
Telephone Number	:	516-231-8480
Fax Number	:	516-231-9164

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT NEAL GOLDSMITH
Credential	:	DMD
Telephone Number	:	860-670-4459

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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