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NPI Code Detail

MEDICARE: DR. JOAN PHYLLIS GOLDSTEIN DDS

MEDICARE: DR. JOAN PHYLLIS GOLDSTEIN DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist19020341IL

General Provider Information

NPI Number : 1124195185
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOAN PHYLLIS GOLDSTEIN DDS
Provider Business Mailing Address
First Line : 55 E WASHINTON #2902
Second Line : COSMETIC DENTAL CENTER OF CHICAGO PC
City : CHICAGO
State : IL
Zip : 60602
Country : US
Telephone Number : 312-263-2447
Fax Number : 312-263-2158
Provider Business Practice Location Address
First Line : 55 E WASHINGTON
Second Line : #2902
City : CHICAGO
State : IL
Zip : 60602
Country : US
Telephone Number : 312-263-2447
Fax Number : 312-263-2158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 07/08/2007

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