NPIMap

Organization Active NPI

Clarence Center Family Dental PLLC

  • General Practice Dentistry
  • Clarence Center, NY
National Provider Identifier
1124300074
Registry record updated Sep 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0494591 Issued in NY
Legal business name
CLARENCE CENTER FAMILY DENTAL PLLC
Practice address
5860 Goodrich Rd
Clarence Center, NY 14032-9258
Phone
(716) 741-9774
Fax
(716) 741-4469
NPI assigned
Sep 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ryan Barrett Goldstein, DDS
Title
Owner/Partner
Phone
(716) 741-9774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 0494591 NY Primary

Addresses

Primary practice location

5860 Goodrich Rd
Clarence Center, NY 14032-9258

Mailing address

5860 Goodrich Rd
Clarence Center, NY 14032-9258
Phone (716) 741-9774

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316131200000",
    "number": "1124300074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5860 GOODRICH RD",
            "city": "CLARENCE CENTER",
            "state": "NY",
            "postal_code": "140329258",
            "telephone_number": "716-741-9774",
            "fax_number": "716-741-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5860 GOODRICH RD",
            "city": "CLARENCE CENTER",
            "state": "NY",
            "postal_code": "140329258",
            "telephone_number": "716-741-9774",
            "fax_number": "716-741-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARENCE CENTER FAMILY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-16",
        "last_updated": "2011-09-16",
        "status": "A",
        "authorized_official_last_name": "GOLDSTEIN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "BARRETT",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "716-741-9774",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0494591",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarence Center, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.