Provider Demographics
NPI:1619078169
Name:GOLDBERG, DAVID A (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3941
Mailing Address - Country:US
Mailing Address - Phone:908-756-7619
Mailing Address - Fax:908-756-5694
Practice Address - Street 1:176 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3941
Practice Address - Country:US
Practice Address - Phone:908-756-7619
Practice Address - Fax:908-756-5694
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ125061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics