Provider Demographics
NPI:1568661544
Name:GOLDSTEIN, GARY S (DMD,MPH)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-523-4555
Mailing Address - Fax:617-227-2767
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-523-4555
Practice Address - Fax:617-227-2767
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice