Healthcare Provider Details

I. General information

NPI: 1497452627
Provider Name (Legal Business Name): GOLDSTEIN FAMILY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE # 1601
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

2 N CENTRAL AVE # 1601
PHOENIX AZ
85004-2322
US

V. Phone/Fax

Practice location:
  • Phone: 602-492-6759
  • Fax:
Mailing address:
  • Phone: 602-492-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: STEVEN HARRIS GOLDSTEIN
Title or Position: OWNER
Credential: DDS
Phone: 602-492-6759