MEDICARE: DR. ANDREW GOLD OLIPHANT D.D.S.

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	1223G0001X	General Practice Dentistry	34356	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1316928328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW GOLD OLIPHANT D.D.S.

Provider Business Mailing Address
First Line	:	245 E 24TH ST
Second Line	:	APT &-C
City	:	NEW YORK
State	:	NY
Zip	:	10010-3821
Country	:	US
Telephone Number	:	212-889-0168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 CORTELYOU RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5403
Country	:	US
Telephone Number	:	718-282-4998
Fax Number	:	718-282-0514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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