Provider Demographics
NPI:1619057742
Name:GOLD, ALAN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:DAVID
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 1:1536 OLD CEDAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2631
Mailing Address - Country:US
Mailing Address - Phone:516-484-0565
Mailing Address - Fax:
Practice Address - Street 1:1626 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1640
Practice Address - Country:US
Practice Address - Phone:718-423-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038734-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist