MEDICARE: DR. ROBERT GOLDBERG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS018200L	PA

General Provider Information

NPI Number	:	1528100526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GOLDBERG D.D.S.

Provider Business Mailing Address
First Line	:	1308 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3606
Country	:	US
Telephone Number	:	215-745-5100
Fax Number	:	215-745-7298

Provider Business Practice Location Address
First Line	:	1308 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3606
Country	:	US
Telephone Number	:	215-745-5100
Fax Number	:	215-745-7298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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