Provider Demographics
NPI:1386038990
Name:ANDREW J. GOLDENBERG PC
Entity Type:Organization
Organization Name:ANDREW J. GOLDENBERG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:D,D,S,
Authorized Official - Phone:805-495-9810
Mailing Address - Street 1:176 AUBURN COURT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-495-9810
Mailing Address - Fax:
Practice Address - Street 1:176 AUBURN COURT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-495-9810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty