Provider Demographics
NPI:1326153156
Name:GOTT, ERIC T (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:T
Last Name:GOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5713
Mailing Address - Country:US
Mailing Address - Phone:516-781-9700
Mailing Address - Fax:516-781-1936
Practice Address - Street 1:2592 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5713
Practice Address - Country:US
Practice Address - Phone:516-781-9700
Practice Address - Fax:516-781-1936
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0437971223G0001X
KY0360061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice