Provider Demographics
NPI:1437282910
Name:GOYKMAN BARON, INNA (DDS)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:GOYKMAN BARON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 CROPSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5856
Mailing Address - Country:US
Mailing Address - Phone:718-234-5858
Mailing Address - Fax:718-234-5505
Practice Address - Street 1:1706 CROPSEY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5856
Practice Address - Country:US
Practice Address - Phone:718-234-5858
Practice Address - Fax:718-234-5505
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01491749Medicaid