Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DS040657 | PA |
NPI | 1104205806 |
---|---|
Provider Name | Jeffrey Seth Goldstein |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-5425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2015 |
Last Update Date | 11/02/2021 |