Provider Demographics
NPI:1083752687
Name:GOLDENSTEIN, MARVIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:D
Last Name:GOLDENSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:SUITE H-1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-971-7181
Mailing Address - Fax:602-992-8897
Practice Address - Street 1:16620 N 40TH ST
Practice Address - Street 2:SUITE H-1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3348
Practice Address - Country:US
Practice Address - Phone:602-971-7181
Practice Address - Fax:602-992-8897
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ37381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery