Provider Demographics
NPI:1093899205
Name:GOLDBERG, ROLAND (DDS)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:GOLDBERG
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 1:8915 TOWNE CENTRE DR
Mailing Address - Street 2:STE#112-114
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5650
Mailing Address - Country:US
Mailing Address - Phone:858-558-7713
Mailing Address - Fax:858-558-7849
Practice Address - Street 1:8915 TOWNE CENTRE DR
Practice Address - Street 2:STE#112-114
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5650
Practice Address - Country:US
Practice Address - Phone:858-558-7713
Practice Address - Fax:858-558-7849
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice