# PEDIATRIC DENTISTRY OF LONG ISLAND

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629469499
- **Authorized official:** DR. SCOTT LOUIS GOLDSTEIN DDS (CEO)
- **Authorized official phone:** (631) 654-4242

## Contact information

- **Practice address:** 1719 N OCEAN AVE STE C, MEDFORD, NY 11763-2669
- **Practice address phone:** (631) 654-4242
- **Practice address fax:** (631) 654-4291
- **Mailing address:** 1719 N OCEAN AVE STE C, MEDFORD, NY 11763-2669
- **Mailing address phone:** (631) 654-4242
- **Mailing address fax:** (631) 654-4291

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 041152 | NY | Yes |

## Other

- **Enumeration date:** 02/13/2015
- **Last updated:** 02/13/2015