Provider Demographics
NPI:1336470061
Name:MICHAEL KORNGOLD DDS PLLC
Entity Type:Organization
Organization Name:MICHAEL KORNGOLD DDS PLLC
Other - Org Name:BERNFELD & KORNGOLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KORNGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-252-8989
Mailing Address - Street 1:1801 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5348
Mailing Address - Country:US
Mailing Address - Phone:718-252-8989
Mailing Address - Fax:718-377-3062
Practice Address - Street 1:1801 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5348
Practice Address - Country:US
Practice Address - Phone:718-252-8989
Practice Address - Fax:718-377-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty