Provider Demographics
NPI:1568500452
Name:GOLDBERG, C. ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:C. ROBERT
Middle Name:
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 1:40 GROVE ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7702
Mailing Address - Country:US
Mailing Address - Phone:781-237-1801
Mailing Address - Fax:
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:SUITE 420
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7702
Practice Address - Country:US
Practice Address - Phone:781-237-1801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125701223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics