Provider Demographics
NPI:1699859108
Name:GOLDSTEIN, TRACY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:
Last Name:GOLDSTEIN
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 1:5638 NC HIGHWAY 42 W
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7998
Mailing Address - Country:US
Mailing Address - Phone:919-661-6161
Mailing Address - Fax:919-661-6820
Practice Address - Street 1:5638 NC HIGHWAY 42 W
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7998
Practice Address - Country:US
Practice Address - Phone:919-661-6161
Practice Address - Fax:919-661-6820
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice