Provider Demographics
NPI:1225185333
Name:GOLDBERG, JORDAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TRENTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-1392
Mailing Address - Country:US
Mailing Address - Phone:856-547-0100
Mailing Address - Fax:856-547-3105
Practice Address - Street 1:110 TRENTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1392
Practice Address - Country:US
Practice Address - Phone:856-547-0100
Practice Address - Fax:856-547-3105
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI015118001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice