MEDICARE: DR. BENJAMIN M GOLDBERG 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	1223G0001X	General Practice Dentistry	8172	FL

General Provider Information

NPI Number	:	1609002369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN M GOLDBERG D.M.D.

Provider Business Mailing Address
First Line	:	5770 WILES RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2156
Country	:	US
Telephone Number	:	954-255-5166
Fax Number	:

Provider Business Practice Location Address
First Line	:	5770 WILES RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2156
Country	:	US
Telephone Number	:	954-255-5166
Fax Number	:

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

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	06/08/2009

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