Susan L Goldstein, D.M.D.
Individual provider Active NPI General Practice Dentistry · Matton, IL
NPI 1346394483 · NPPES record last updated Sep 19, 2007
Key facts
- NPI
- 1346394483
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 18 S. Country Club Rd.
Matton, IL 61938 - Phone
- (217) 234-2786
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019019331 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
18 S. Country Club Rd.
Matton, IL 61938
Mailing address
18 S Country Club Rd
Mattoon, IL 61938-9006
Phone (217) 234-2786
Other providers in Matton, IL
All providers in Matton, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.