Provider Demographics
NPI:1467616474
Name:FULOP-GOODLING, JACQUELINE I (DMD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:I
Last Name:FULOP-GOODLING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EAST 40TH STREET
Mailing Address - Street 2:SUITE 806
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-972-3522
Mailing Address - Fax:646-619-4960
Practice Address - Street 1:30 EAST 40TH STREET
Practice Address - Street 2:SUITE 806
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-972-3522
Practice Address - Fax:646-619-4960
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDN0467621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics