Provider Demographics
NPI:1073527610
Name:GOLDBERG, JOEL HENRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:HENRY
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6640 EMBASSY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4737
Mailing Address - Country:US
Mailing Address - Phone:727-847-9631
Mailing Address - Fax:727-848-1369
Practice Address - Street 1:6640 EMBASSY BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4737
Practice Address - Country:US
Practice Address - Phone:727-847-9631
Practice Address - Fax:727-848-1369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN74961223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics