Lawrence Edward Goettisheim, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

039336 Issued in NY

Practice address

103 South Bedford Rd
Suite 110
Mt Kisco, NY 10549-3452

Phone

(914) 241-7670

Fax

(914) 241-7254

NPI assigned

Nov 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609945419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SOUTH BEDFORD RD",
            "address_2": "SUITE 110",
            "city": "MT KISCO",
            "state": "NY",
            "postal_code": "105493452",
            "telephone_number": "914-241-7670",
            "fax_number": "914-241-7254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SOUTH BEDFORD RD",
            "address_2": "SUITE 110",
            "city": "MT KISCO",
            "state": "NY",
            "postal_code": "105493452",
            "telephone_number": "914-241-7670",
            "fax_number": "914-241-7254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOETTISHEIM",
        "first_name": "LAWRENCE",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NY",
            "license": "039336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gracie B Glast, L.P.N.
• Global Empire Care LLC
• Alexandria J Glover
• Barbara Godlewska
• Ann Marie Goelitz, PHD, LCSW
• Eugene Nicholas Goetz, DMD
• Barbara Goldblum, M.D.
• Trudie Goldmann, PH. D.
• Amy Jill Goldstein, LCSW
• Rachel Lindsey Gomez, P.A.

• Periodontics in Mount Kisco, NY
• Providers in Mount Kisco, NY by specialty
• Periodontics in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.