Healthcare Provider Details

I. General information

NPI: 1619078169
Provider Name (Legal Business Name): DAVID A GOLDBERG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 CEDAR ST
NORTH PLAINFIELD NJ
07060-3941
US

IV. Provider business mailing address

176 CEDAR ST
NORTH PLAINFIELD NJ
07060-3941
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-7619
  • Fax: 908-756-5694
Mailing address:
  • Phone: 908-756-7619
  • Fax: 908-756-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12506
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: