Healthcare Provider Details

I. General information

NPI: 1568536308
Provider Name (Legal Business Name): ROBERT ALAN GOLDBERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MCHENRY RD SUITE 121
BUFFALO GROVE IL
60089-1382
US

IV. Provider business mailing address

1401 MCHENRY RD SUITE 121
BUFFALO GROVE IL
60089-1382
US

V. Phone/Fax

Practice location:
  • Phone: 847-913-7700
  • Fax: 847-913-7710
Mailing address:
  • Phone: 847-913-7700
  • Fax: 847-913-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: