Provider Demographics
NPI:1326144247
Name:GOLDSTEIN, VANCE (DDS)
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:
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 1:206 LIVINGSTON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7266
Mailing Address - Country:US
Mailing Address - Phone:718-638-3900
Mailing Address - Fax:347-335-0382
Practice Address - Street 1:206 LIVINGSTON ST STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7266
Practice Address - Country:US
Practice Address - Phone:718-638-3900
Practice Address - Fax:347-335-0382
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist