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NPI Code Detail

MEDICARE: DR. MICHAEL LEONARD GOLDSTEIN D.D.S.

MEDICARE: DR. MICHAEL LEONARD GOLDSTEIN 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
11223G0001XGeneral Practice Dentistry8061MN

General Provider Information

NPI Number : 1922082601
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL LEONARD GOLDSTEIN D.D.S.
Provider Business Mailing Address
First Line : 3145 HENNEPIN AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2620
Country : US
Telephone Number : 612-823-8600
Fax Number : 612-823-3185
Provider Business Practice Location Address
First Line : 3145 HENNEPIN AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2620
Country : US
Telephone Number : 612-823-8600
Fax Number : 612-823-3185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 07/08/2007

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