Provider Demographics
NPI:1003214057
Name:JOAN P GOLDSTEIN D.D.S.,P.C.
Entity Type:Organization
Organization Name:JOAN P GOLDSTEIN D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-945-9563
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3745
Mailing Address - Country:US
Mailing Address - Phone:312-945-9563
Mailing Address - Fax:
Practice Address - Street 1:1032 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3578
Practice Address - Country:US
Practice Address - Phone:312-945-9563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty