Healthcare Provider Details

I. General information

NPI: 1922919661
Provider Name (Legal Business Name): NATHAN GOLDSBERRY DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BRIDGE ST
WASHINGTON NC
27889
US

IV. Provider business mailing address

25234 LAWTON AVE
LOMA LINDA CA
92354-3541
US

V. Phone/Fax

Practice location:
  • Phone: 252-362-6020
  • Fax:
Mailing address:
  • Phone: 801-694-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14992
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: