Individual
EVAN SCOTT GOLDSTEIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1839 CENTRAL AVE, ALBANY, NY 12205-4748
(518) 464-0402
(518) 464-0409
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 546-3333
(719) 546-3334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052265
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02667210
—
NY
Enumeration date
12/27/2005
Last updated
07/09/2007
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