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NPI Code Detail

MEDICARE: DR. PRESTON JAN GOLDNER D.D.S

MEDICARE: DR. PRESTON JAN GOLDNER D.D.S
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
1122300000XDentist037561NY
21223G0001XGeneral Practice Dentistry10635NC
31223G0001XGeneral Practice Dentistry8860SC

General Provider Information

NPI Number : 1740389535
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRESTON JAN GOLDNER D.D.S
Provider Business Mailing Address
First Line : 2325 TALON POINT CIR
Second Line :
City : FORT MILL
State : SC
Zip : 29715-0146
Country : US
Telephone Number : 516-680-4045
Fax Number :
Provider Business Practice Location Address
First Line : 3333 WILKINSON BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-5631
Country : US
Telephone Number : 704-393-7720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 01/07/2021

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