Provider Demographics
NPI:1508843178
Name:GOLD, SAMUEL HARRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:HARRY
Last Name:GOLD
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 1:185 W END AVE
Mailing Address - Street 2:SUITE #1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5539
Mailing Address - Country:US
Mailing Address - Phone:212-787-8183
Mailing Address - Fax:212-874-8775
Practice Address - Street 1:185 W END AVE
Practice Address - Street 2:SUITE #1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5539
Practice Address - Country:US
Practice Address - Phone:212-787-8183
Practice Address - Fax:212-874-8775
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice