Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 010028 | GA |
NPI | 1205922697 |
---|---|
Provider Name | Dr. Cary Ellis Goldstein |
First Address | Atlanta, GA 30305-1315 |
Second Address | Atlanta, GA 30305-1315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |