Provider Demographics
NPI:1336298017
Name:ROYAL PALM DENTAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ROYAL PALM DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-790-0177
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN105031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty