Provider Demographics
NPI:1679514897
Name:GOLDSTEIN, SCOTT C (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:GOLDSTEIN
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 1:407 HIGH ST
Mailing Address - Street 2:PO BOX 630
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-8451
Mailing Address - Country:US
Mailing Address - Phone:417-845-6384
Mailing Address - Fax:
Practice Address - Street 1:407 HIGH ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-8451
Practice Address - Country:US
Practice Address - Phone:417-845-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist