Provider Demographics
NPI:1639294507
Name:GOODKIN & PILEK FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:GOODKIN & PILEK FAMILY DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-876-5225
Mailing Address - Street 1:59 E. MILL RD
Mailing Address - Street 2:SUITE 2-2034
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853
Mailing Address - Country:US
Mailing Address - Phone:908-876-5225
Mailing Address - Fax:908-876-1062
Practice Address - Street 1:59 E. MILL RD
Practice Address - Street 2:SUITE 2-2034
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853
Practice Address - Country:US
Practice Address - Phone:908-876-5225
Practice Address - Fax:908-876-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ153611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1663003-01Medicaid