Healthcare Provider Details

I. General information

NPI: 1992896823
Provider Name (Legal Business Name): HOWARD IAN GOLDSTEIN DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 FORWARD AVE SUITE 200
PITTSBURGH PA
15217-2255
US

IV. Provider business mailing address

5725 FORWARD AVE SUITE 200
PITTSBURGH PA
15217-2255
US

V. Phone/Fax

Practice location:
  • Phone: 412-521-3590
  • Fax: 412-521-3593
Mailing address:
  • Phone: 412-521-3590
  • Fax: 412-521-3593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS036438
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: