Healthcare Provider Details

I. General information

NPI: 1093104440
Provider Name (Legal Business Name): BRIAN GOLDSTEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 OLD CHIMNEY RD
UPPER SADDLE RIVER NJ
07458-1538
US

IV. Provider business mailing address

24 OLD CHIMNEY RD
UPPER SADDLE RIVER NJ
07458-1538
US

V. Phone/Fax

Practice location:
  • Phone: 516-330-0220
  • Fax:
Mailing address:
  • Phone: 516-330-0220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDBS9273
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019.032977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: