Provider Demographics
NPI:1295710184
Name:GOUZ, ANDRIJ (DDS)
Entity type:Individual
Prefix:
First Name:ANDRIJ
Middle Name:
Last Name:GOUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:502 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1813
Mailing Address - Country:US
Mailing Address - Phone:718-643-9010
Mailing Address - Fax:718-643-9020
Practice Address - Street 1:502A ATLANTIC AVE
Practice Address - Street 2:ATLANTIC DENTAL CARE PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1813
Practice Address - Country:US
Practice Address - Phone:718-643-9010
Practice Address - Fax:718-643-9020
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0506441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY02405356Medicaid