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General NPI Number Information
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NPI Number | 1235508508
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Entity Type | Organization
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Legal Business Name | GOLDENBERG DENTAL, INC.
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 5700 RALSTON ST SUITE 310
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City | VENTURA
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State | CA
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Zip | 93003-7869
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Country | US
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Telephone | 805-642-4541
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Fax | 805-642-5621
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Provider Business Mailing Address
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Address Line | 5700 RALSTON STREET SUITE 310
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City | VENTURA
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State | CA
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Zip | 93003-7869
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Country | US
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Telephone | 805-642-4541
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Fax | 805-642-5621
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL ALAN GOLDENBERG
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Credential | DDS
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Telephone | 805-642-4541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 31269
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License Number State | CA
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