Provider Demographics
NPI:1073734257
Name:GOLDSTEIN, LOREN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:D
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 1:707 OSTERMAN AVE
Mailing Address - Street 2:# 1129
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-6270
Mailing Address - Country:US
Mailing Address - Phone:847-317-1611
Mailing Address - Fax:
Practice Address - Street 1:707 OSTERMAN AVE
Practice Address - Street 2:# 1129
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-6270
Practice Address - Country:US
Practice Address - Phone:847-317-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019018067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist