Provider Demographics
NPI:1912052200
Name:GOLDNER-RADO, IUDIT (DDS)
Entity Type:Individual
Prefix:
First Name:IUDIT
Middle Name:
Last Name:GOLDNER-RADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10230 67TH AVE
Mailing Address - Street 2:APT. #6N
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2455
Mailing Address - Country:US
Mailing Address - Phone:718-897-6004
Mailing Address - Fax:718-426-2232
Practice Address - Street 1:9211 35TH AVE
Practice Address - Street 2:1K
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5866
Practice Address - Country:US
Practice Address - Phone:718-426-2231
Practice Address - Fax:718-426-2232
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0413721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02256357Medicaid