MEDICARE: DR. JOEL S. GOLDBERG

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	122300000X	Dentist	19A1605	IL

General Provider Information

NPI Number	:	1649427550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL S. GOLDBERG

Provider Business Mailing Address
First Line	:	1420 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4824
Country	:	US
Telephone Number	:	847-392-6610
Fax Number	:	847-394-4189

Provider Business Practice Location Address
First Line	:	1420 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4824
Country	:	US
Telephone Number	:	847-392-6610
Fax Number	:	847-394-4189

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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