Provider Demographics
NPI:1144221235
Name:GOLDENBERG, JOEL ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ALAN
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 RALSTON ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6050
Mailing Address - Country:US
Mailing Address - Phone:805-642-4541
Mailing Address - Fax:805-642-5621
Practice Address - Street 1:5700 RALSTON ST
Practice Address - Street 2:SUITE 303
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6050
Practice Address - Country:US
Practice Address - Phone:805-642-4541
Practice Address - Fax:805-642-5621
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice