Provider Demographics
NPI:1326189853
Name:GOLDBERG, ALAN KENNETH (DDS)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:KENNETH
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 1:129 EASTON ST NE
Mailing Address - Street 2:
Mailing Address - City:N CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721
Mailing Address - Country:US
Mailing Address - Phone:330-499-2004
Mailing Address - Fax:330-494-3402
Practice Address - Street 1:129 EASTON ST NE
Practice Address - Street 2:
Practice Address - City:N CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721
Practice Address - Country:US
Practice Address - Phone:330-499-2004
Practice Address - Fax:330-494-3402
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice