Provider Demographics
NPI:1790033538
Name:GOLDSTEIN DENTAL OFFICE, LLC
Entity Type:Organization
Organization Name:GOLDSTEIN DENTAL OFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:417-845-6384
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:407 HIGH ST
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831
Mailing Address - Country:US
Mailing Address - Phone:417-845-6384
Mailing Address - Fax:417-845-8038
Practice Address - Street 1:407 HIGH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831
Practice Address - Country:US
Practice Address - Phone:417-845-6384
Practice Address - Fax:417-845-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty