Provider Demographics
NPI:1982785564
Name:GOEL, AVIJIT (DMD)
Entity Type:Individual
Prefix:
First Name:AVIJIT
Middle Name:
Last Name:GOEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 BREIDABLIK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1925
Mailing Address - Country:US
Mailing Address - Phone:914-420-2053
Mailing Address - Fax:
Practice Address - Street 1:1401 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4124
Practice Address - Country:US
Practice Address - Phone:914-420-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366891223X0400X, 122300000X
IADDS-09066122300000X
IA090661223X0400X
DEG1-0001283122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0300XDental ProvidersDentistPeriodontics