Provider Demographics
NPI:1609267780
Name:ANTONIO CASANOVA DDS & BRUCE GOLDMAN DMD PLLC
Entity Type:Organization
Organization Name:ANTONIO CASANOVA DDS & BRUCE GOLDMAN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-294-0202
Mailing Address - Street 1:901 STEWART AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4893
Mailing Address - Country:US
Mailing Address - Phone:516-294-0202
Mailing Address - Fax:516-294-3564
Practice Address - Street 1:901 STEWART AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4893
Practice Address - Country:US
Practice Address - Phone:516-294-0202
Practice Address - Fax:516-294-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042915261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental