Healthcare Provider Details

I. General information

NPI: 1548584576
Provider Name (Legal Business Name): DANIELLE GOLDSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6868 E BECKER LN SUITE 101
SCOTTSDALE AZ
85254-6708
US

IV. Provider business mailing address

6868 E BECKER LN SUITE 100
SCOTTSDALE AZ
85254-6708
US

V. Phone/Fax

Practice location:
  • Phone: 480-609-8506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD008373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: