Healthcare Provider Details

I. General information

NPI: 1043133754
Provider Name (Legal Business Name): NATALIE GOLDSTONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 SONOMA AVE STE 118
SANTA ROSA CA
95405-4812
US

IV. Provider business mailing address

1144 SONOMA AVE STE 118
SANTA ROSA CA
95405-4812
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-7811
  • Fax:
Mailing address:
  • Phone: 707-545-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: