Provider Demographics
NPI:1326196791
Name:GOLDBERG, DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:11358 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8723
Mailing Address - Country:US
Mailing Address - Phone:561-790-0177
Mailing Address - Fax:561-790-5291
Practice Address - Street 1:11358 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8723
Practice Address - Country:US
Practice Address - Phone:561-790-0177
Practice Address - Fax:561-790-5291
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN105031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice