MEDICARE: DR. SANDY G. GOLDENBERG D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN16622	FL

General Provider Information

NPI Number	:	1184819682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDY G. GOLDENBERG D.M.D

Provider Business Mailing Address
First Line	:	20201 E. COUNTRY CLUB DR.
Second Line	:	#2703
City	:	AVENTURA
State	:	FL
Zip	:	33180
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 NW 2ND AVE STE 102
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6766
Country	:	US
Telephone Number	:	561-395-1190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2007
Last Update Date	:	03/17/2018

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