Provider Demographics
NPI:1063683274
Name:GOLDENBERG, BRUCE NMN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:NMN
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 1:1 ROCKEFELLER PLZ
Mailing Address - Street 2:SUITE 2206
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-2003
Mailing Address - Country:US
Mailing Address - Phone:212-697-6976
Mailing Address - Fax:212-586-4733
Practice Address - Street 1:1 ROCKEFELLER PLZ
Practice Address - Street 2:SUITE 2206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-2003
Practice Address - Country:US
Practice Address - Phone:212-697-6976
Practice Address - Fax:212-586-4733
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist