Healthcare Provider Details

I. General information

NPI: 1306188040
Provider Name (Legal Business Name): HARRY J GOLDSCHEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BEVILLE RD STE 403
DAYTONA BEACH FL
32114
US

IV. Provider business mailing address

1120 STATE ROAD 436 SUITE 1800
CASSELBERRY FL
32707
US

V. Phone/Fax

Practice location:
  • Phone: 386-253-6634
  • Fax: 386-258-8775
Mailing address:
  • Phone: 407-977-7079
  • Fax: 407-677-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN8342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: