Provider Demographics
NPI:1649323031
Name:MAURICE GOLBERG, ALAN MINTZ, LARRY DOVER DDS, PC
Entity type:Organization
Organization Name:MAURICE GOLBERG, ALAN MINTZ, LARRY DOVER DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-757-1457
Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 415
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:212-757-1457
Mailing Address - Fax:212-757-9209
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 415
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:212-757-1457
Practice Address - Fax:212-757-9209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty