Provider Demographics
NPI:1033323720
Name:GOLDBERG, AARON S (DD,S)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:S
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E 3300 S STE 103
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3997
Mailing Address - Country:US
Mailing Address - Phone:801-487-2206
Mailing Address - Fax:801-487-4463
Practice Address - Street 1:1050 E 3300 S STE 103
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3997
Practice Address - Country:US
Practice Address - Phone:801-487-2206
Practice Address - Fax:801-487-4463
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1427491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice