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General NPI Number Information
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NPI Number | 1306313150
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Entity Type | Organization
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Legal Business Name | JEFFREY I GOLDBERG DDS PLLC
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1655 ELMWOOD AVE STE 100
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City | ROCHESTER
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State | NY
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Zip | 14620-3426
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Country | US
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Telephone | 716-636-2222
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Fax | 716-636-2252
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Provider Business Mailing Address
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Address Line | 3980 SHERIDAN DR STE 401
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City | AMHERST
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State | NY
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Zip | 14226-1727
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Country | US
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Telephone | 716-636-2222
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Fax | 716-636-2252
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY I GOLDBERG
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Credential | DDS
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Telephone | 716-636-2222
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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 |
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License Number State |
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