Provider Demographics
NPI:1306416276
Name:GOLDBERG, KATIE MARIE MATTHYS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MARIE MATTHYS
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 1:2750 W MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1830
Mailing Address - Country:US
Mailing Address - Phone:512-786-8519
Mailing Address - Fax:
Practice Address - Street 1:2750 W MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1830
Practice Address - Country:US
Practice Address - Phone:281-554-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373601223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice