MEDICARE: DR. BRUCE E GOLDEN 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	1223P0221X	Pediatric Dentistry	027524	NY

General Provider Information

NPI Number	:	1497874101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE E GOLDEN D.D.S.

Provider Business Mailing Address
First Line	:	15 FISHER LN
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-2222
Country	:	US
Telephone Number	:	914-761-4872
Fax Number	:	914-761-3544

Provider Business Practice Location Address
First Line	:	15 FISHER LN
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10603-2222
Country	:	US
Telephone Number	:	914-761-4872
Fax Number	:	914-761-3544

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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