Provider Demographics
NPI:1326422296
Name:GOLDBERG, SARA BETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:BETH
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 1:104-60 QUEENS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11735
Mailing Address - Country:US
Mailing Address - Phone:718-459-7900
Mailing Address - Fax:
Practice Address - Street 1:104-60 QUEENS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11735
Practice Address - Country:US
Practice Address - Phone:718-459-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041110122300000X
390200000X
NY0593631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program