MEDICARE: DR. MARK ANDREW GOLDBERG DDS

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	1223E0200X	Endodontics	16344	FL

General Provider Information

NPI Number	:	1790008415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ANDREW GOLDBERG DDS

Provider Business Mailing Address
First Line	:	3400 SW 27TH AVE
Second Line	:	APT. 1701
City	:	MIAMI
State	:	FL
Zip	:	33133-5307
Country	:	US
Telephone Number	:	954-328-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 S HIAWASSEE RD
Second Line	:	SUITE 135
City	:	ORLANDO
State	:	FL
Zip	:	32835-6438
Country	:	US
Telephone Number	:	407-293-8324
Fax Number	:	407-298-7810

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	04/26/2010

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