Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | AZ3738 | AZ |
NPI | 1083752687 |
---|---|
Provider Name | Dr. Marvin D Goldenstein |
First Address | Phoenix, AZ 85032-3348 |
Second Address | Phoenix, AZ 85032-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 08/07/2007 |