Provider Demographics
NPI:1902789506
Name:GOLDSTEIN, PARKER (DMD)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 W GRANADA BLVD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8191
Mailing Address - Country:US
Mailing Address - Phone:407-721-1407
Mailing Address - Fax:
Practice Address - Street 1:1345 W GRANADA BLVD UNIT 9
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8191
Practice Address - Country:US
Practice Address - Phone:407-721-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist