Provider Demographics
NPI:1316410319
Name:GOLDBERG AND MYERS DENTISTRY, PLC
Entity Type:Organization
Organization Name:GOLDBERG AND MYERS DENTISTRY, PLC
Other - Org Name:CONVENIENT FAMILY DENTISTRY GRAND BLANC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-694-7450
Mailing Address - Street 1:9499 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8351
Mailing Address - Country:US
Mailing Address - Phone:810-694-7450
Mailing Address - Fax:
Practice Address - Street 1:9499 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8351
Practice Address - Country:US
Practice Address - Phone:810-694-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty