Provider Demographics
NPI:1699801423
Name:GOLDSTEIN, KENNETH PHILIP (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PHILIP
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:840 CHURCH ST NE
Mailing Address - Street 2:BLD D STE1
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8936
Mailing Address - Country:US
Mailing Address - Phone:770-422-3636
Mailing Address - Fax:770-422-6022
Practice Address - Street 1:840 CHURCH ST NE
Practice Address - Street 2:BLD D STE1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8936
Practice Address - Country:US
Practice Address - Phone:770-422-3636
Practice Address - Fax:770-422-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN113341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics