Provider Demographics
NPI:1508396599
Name:GOOCH, PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:GOOCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RAYNHAM DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3909
Mailing Address - Country:US
Mailing Address - Phone:516-282-4248
Mailing Address - Fax:
Practice Address - Street 1:1601 VETERANS MEMORIAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1528
Practice Address - Country:US
Practice Address - Phone:641-348-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0600331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice