Provider Demographics
NPI:1558489336
Name:GOLDSTEIN, GLENN DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:DAVID
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 ROUTE 27
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3979
Mailing Address - Country:US
Mailing Address - Phone:732-249-6800
Mailing Address - Fax:732-249-6835
Practice Address - Street 1:1527 ROUTE 27
Practice Address - Street 2:SUITE 2200
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3979
Practice Address - Country:US
Practice Address - Phone:732-249-6800
Practice Address - Fax:732-249-6835
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI131801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics