Provider Demographics
NPI:1164822557
Name:GOLDBERG, JULIE (DDS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VILLAGE GRN
Mailing Address - Street 2:#150
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3078
Mailing Address - Country:US
Mailing Address - Phone:847-634-3848
Mailing Address - Fax:
Practice Address - Street 1:300 VILLAGE GRN
Practice Address - Street 2:#150
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3078
Practice Address - Country:US
Practice Address - Phone:847-634-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist