Provider Demographics
NPI:1669799714
Name:WEST SIDE KIDS DENTAL, PC
Entity type:Organization
Organization Name:WEST SIDE KIDS DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:212-877-2163
Mailing Address - Street 1:107 W 86TH ST
Mailing Address - Street 2:1 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3409
Mailing Address - Country:US
Mailing Address - Phone:212-877-2163
Mailing Address - Fax:212-877-2133
Practice Address - Street 1:107 W 86TH ST
Practice Address - Street 2:1 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3409
Practice Address - Country:US
Practice Address - Phone:212-877-2163
Practice Address - Fax:212-877-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052974-1261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental