Healthcare Provider Details

I. General information

NPI: 1396395919
Provider Name (Legal Business Name): STEPHEN L. GOLDFADEN, DDS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 NW 13TH ST STE 2
GAINESVILLE FL
32609-3414
US

IV. Provider business mailing address

1905 NW 13TH ST
GAINESVILLE FL
32609-3414
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-7776
  • Fax:
Mailing address:
  • Phone: 352-375-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: ADELE GOLDFADEN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 352-375-7776