Provider Demographics
NPI:1235369166
Name:GOLDSTEIN, RYAN B (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:B
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 1:1259 CLEVELAND DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1834
Mailing Address - Country:US
Mailing Address - Phone:716-635-4720
Mailing Address - Fax:716-635-4724
Practice Address - Street 1:1259 CLEVELAND DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1834
Practice Address - Country:US
Practice Address - Phone:716-635-4720
Practice Address - Fax:716-635-4724
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049459-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice