Provider Demographics
NPI:1033258579
Name:GOLDSTEIN, LOREN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:RICHARD
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5723
Mailing Address - Country:US
Mailing Address - Phone:516-766-5250
Mailing Address - Fax:516-766-7594
Practice Address - Street 1:18 DAVISON AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2237
Practice Address - Country:US
Practice Address - Phone:516-766-5250
Practice Address - Fax:516-766-7594
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist