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General NPI Number Information
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NPI Number | 1447600119
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Entity Type | Individual
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Provider Name | JASON MICHAEL GOLDBERG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 6520 N 7TH AVE STE 5
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City | PHOENIX
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State | AZ
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Zip | 85013
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Country | US
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Telephone | 602-277-5304
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Fax |
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Provider Business Mailing Address
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Address Line | 8107 E VIA DEL FUTURO
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3712
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Country | US
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Telephone | 704-530-8406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D012125
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 11912
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License Number State | NC
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