Provider Demographics
NPI:1134298748
Name:GOLDBERG, ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
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 1:1825 BARNUM AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5333
Mailing Address - Country:US
Mailing Address - Phone:203-375-6090
Mailing Address - Fax:203-378-0762
Practice Address - Street 1:1825 BARNUM AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5333
Practice Address - Country:US
Practice Address - Phone:203-375-6090
Practice Address - Fax:203-378-0762
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT42681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice