Healthcare Provider Details

I. General information

NPI: 1720072671
Provider Name (Legal Business Name): PAUL STANLEY GOLDSTEIN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6117 220TH ST
OAKLAND GARDENS NY
11364-2244
US

IV. Provider business mailing address

6117 220TH ST
OAKLAND GARDENS NY
11364-2244
US

V. Phone/Fax

Practice location:
  • Phone: 718-225-2131
  • Fax:
Mailing address:
  • Phone: 718-225-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number033678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: