Provider Demographics
NPI:1053461905
Name:GOLDSTEIN, CARY NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:NEIL
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 1:29134 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2468
Mailing Address - Country:US
Mailing Address - Phone:440-943-3003
Mailing Address - Fax:440-943-3024
Practice Address - Street 1:29134 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-2468
Practice Address - Country:US
Practice Address - Phone:440-943-3003
Practice Address - Fax:440-943-3024
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560236Medicaid