Provider Demographics
NPI:1487664819
Name:GOLDIN, CLIVE STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:STANLEY
Last Name:GOLDIN
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 1:3267 LAYTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:718-597-1490
Mailing Address - Fax:718-597-1928
Practice Address - Street 1:3267 LAYTON AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:718-597-1490
Practice Address - Fax:718-597-1928
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist