Provider Demographics
NPI:1417077215
Name:GOLDBERG, LLOYD IRA (DDS)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:IRA
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 1:160 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5715
Mailing Address - Country:US
Mailing Address - Phone:203-838-3161
Mailing Address - Fax:203-866-8528
Practice Address - Street 1:160 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5715
Practice Address - Country:US
Practice Address - Phone:203-838-3161
Practice Address - Fax:203-866-8528
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076891223G0001X
NY04058411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice