Provider Demographics
NPI:1760925523
Name:AMERICAN FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVIJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:914-420-2053
Mailing Address - Street 1:325 21ST ST NW UNIT B
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2019
Mailing Address - Country:US
Mailing Address - Phone:914-420-2053
Mailing Address - Fax:
Practice Address - Street 1:325 21ST ST NW UNIT B
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2019
Practice Address - Country:US
Practice Address - Phone:914-420-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty