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NPI Code Detail

MEDICARE: DR. AVERY DEAN GOLDBERG D.D.S.

MEDICARE: DR. AVERY DEAN 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
11223S0112XOral and Maxillofacial Surgery (Dentist)DN19202FL

General Provider Information

NPI Number : 1619178852
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AVERY DEAN GOLDBERG D.D.S.
Provider Business Mailing Address
First Line : 2045 LEE RD
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-1836
Country : US
Telephone Number : 407-629-4444
Fax Number : 407-629-9078
Provider Business Practice Location Address
First Line : 2045 LEE RD
Second Line :
City : WINTER PARK
State : FL
Zip : 32789-1836
Country : US
Telephone Number : 407-629-4444
Fax Number : 407-629-9078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2007
Last Update Date : 05/22/2015

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