MEDICARE: ADMIRALTY DENTAL ASSOCIATES, P.A.

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	261QD0000X	Dental Clinic/Center	09850	NJ

General Provider Information

NPI Number	:	1750551933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADMIRALTY DENTAL ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	1033 RIVER RD
Second Line	:	UNIT #4
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1351
Country	:	US
Telephone Number	:	201-224-0900
Fax Number	:	201-943-4574

Provider Business Practice Location Address
First Line	:	1033 RIVER RD
Second Line	:	UNIT #4
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1351
Country	:	US
Telephone Number	:	201-224-0900
Fax Number	:	201-943-4574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH L GOLDBERG
Credential	:	D.M.D.
Telephone Number	:	201-224-0900

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	03/04/2008

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