MEDICARE: GOLBARG RAZBAN DMD

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	1223P0221X	Pediatric Dentistry	0401419320	VA
2	1223P0221X	Pediatric Dentistry	062689	NY

General Provider Information

NPI Number	:	1851913990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GOLBARG RAZBAN DMD

Provider Business Mailing Address
First Line	:	370 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1604
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1604
Country	:	US
Telephone Number	:	585-424-5005
Fax Number	:

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

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	03/04/2025

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