Provider Demographics
NPI:1629277694
Name:GARY S. GOLDSTEIN, DMD, PC
Entity Type:Organization
Organization Name:GARY S. GOLDSTEIN, DMD, PC
Other - Org Name:CHARLES RIVER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:617-523-4555
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty