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NPI Code Detail

MEDICARE: A-GOLD COAST FAMILY DENTAL

MEDICARE: A-GOLD COAST FAMILY DENTAL
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
1122300000XDentist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174705768
Entity Type Code : Organization
Provider Name (Legal Business Name) : A-GOLD COAST FAMILY DENTAL
Provider Business Mailing Address
First Line : 2 COW NECK RD
Second Line :
City : PORT WASHINGTON
State : NY
Zip : 11050-1712
Country : US
Telephone Number : 516-883-8810
Fax Number :
Provider Business Practice Location Address
First Line : 2 COW NECK RD
Second Line :
City : PORT WASHINGTON
State : NY
Zip : 11050-1712
Country : US
Telephone Number : 516-883-8810
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. DORON KEREN
Credential : D.D.S.
Telephone Number : 516-883-8810
Provider Enumeration Date : 12/05/2007
Last Update Date : 12/05/2007

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Directions to “A-GOLD COAST FAMILY DENTAL ” Practice Location

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