Provider Demographics
NPI:1053432534
Name:GOLDSTON, SHADID HUGH (DDS)
Entity type:Individual
Prefix:
First Name:SHADID
Middle Name:HUGH
Last Name:GOLDSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79008-0068
Mailing Address - Country:US
Mailing Address - Phone:806-273-6451
Mailing Address - Fax:806-273-6456
Practice Address - Street 1:301 S MCGEE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4617
Practice Address - Country:US
Practice Address - Phone:806-273-6451
Practice Address - Fax:806-273-6456
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88D678OtherBLUECROSS BLUESHIELD
TX1613454OtherUNITED CONCORDIA