Provider Demographics
NPI:1972671238
Name:GOTTLIEB, DAVID S (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOTT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850
Mailing Address - Country:US
Mailing Address - Phone:203-853-1120
Mailing Address - Fax:203-866-1999
Practice Address - Street 1:10 MOTT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850
Practice Address - Country:US
Practice Address - Phone:203-853-1120
Practice Address - Fax:203-866-1999
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT38281223P0300X
NY024922-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics