Provider Demographics
NPI:1003048455
Name:GOLDBERG, JEFFREY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
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 1:315 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4936
Mailing Address - Country:US
Mailing Address - Phone:336-887-3168
Mailing Address - Fax:336-886-6019
Practice Address - Street 1:315 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4936
Practice Address - Country:US
Practice Address - Phone:336-887-3168
Practice Address - Fax:336-886-6019
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMADN18552461223X0400X
NC102131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty