Healthcare Provider Details

I. General information

NPI: 1992093264
Provider Name (Legal Business Name): HOWELL A GOLDBERG DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S UNIVERSITY DR STE 102
PLANTATION FL
33324-3312
US

IV. Provider business mailing address

815 S UNIVERSITY DR STE 102
PLANTATION FL
33324-3312
US

V. Phone/Fax

Practice location:
  • Phone: 954-472-3303
  • Fax: 954-472-1055
Mailing address:
  • Phone: 954-472-3303
  • Fax: 954-472-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9212
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWELL ANDREW GOLDBERG
Title or Position: OWNER
Credential: DDS
Phone: 954-472-3303