Provider Demographics
NPI:1962824102
Name:GOLDSTEIN, MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4752
Mailing Address - Country:US
Mailing Address - Phone:516-365-5439
Mailing Address - Fax:516-442-1019
Practice Address - Street 1:2211 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4752
Practice Address - Country:US
Practice Address - Phone:516-365-5439
Practice Address - Fax:516-442-1019
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0573391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program