Healthcare Provider Details

I. General information

NPI: 1922231026
Provider Name (Legal Business Name): HARLAN GENE GOLDBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 NE 25TH AVE SUITE 801
OCALA FL
34470-8800
US

IV. Provider business mailing address

1801 SE 32ND AVE
OCALA FL
34471-5532
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-2664
  • Fax: 352-622-2899
Mailing address:
  • Phone: 352-622-2664
  • Fax: 352-622-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDTC 161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: