Provider Demographics
NPI:1447579453
Name:GOLDBERG, ADAM ZACHARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ZACHARY
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 BEVERLY HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3161
Mailing Address - Country:US
Mailing Address - Phone:706-860-1484
Mailing Address - Fax:706-868-6856
Practice Address - Street 1:1016 BEVERLY HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3161
Practice Address - Country:US
Practice Address - Phone:706-860-1484
Practice Address - Fax:706-868-6856
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice