Healthcare Provider Details

I. General information

NPI: 1982777439
Provider Name (Legal Business Name): BART L GOLDSBERRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S 700 E
SALT LAKE CITY UT
84102-2171
US

IV. Provider business mailing address

223 S 700 E
SALT LAKE CITY UT
84102-2171
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-5264
  • Fax: 801-359-5265
Mailing address:
  • Phone: 801-359-5264
  • Fax: 801-359-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number96-317730-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: