Provider Demographics
NPI:1316928328
Name:OLIPHANT, ANDREW GOLD (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:GOLD
Last Name:OLIPHANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 24TH ST
Mailing Address - Street 2:APT &-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3821
Mailing Address - Country:US
Mailing Address - Phone:212-889-0168
Mailing Address - Fax:
Practice Address - Street 1:1201 CORTELYOU RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5403
Practice Address - Country:US
Practice Address - Phone:718-282-4998
Practice Address - Fax:718-282-0514
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00572243Medicaid