Provider Demographics
NPI:1396395919
Name:STEPHEN L. GOLDFADEN, DDS,PA
Entity Type:Organization
Organization Name:STEPHEN L. GOLDFADEN, DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-375-7776
Mailing Address - Street 1:1905 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3414
Mailing Address - Country:US
Mailing Address - Phone:352-375-7776
Mailing Address - Fax:
Practice Address - Street 1:1905 NW 13TH ST STE 2
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3414
Practice Address - Country:US
Practice Address - Phone:352-375-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty