Provider Demographics
NPI:1629166152
Name:GOLDBERG, BETH MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:MICHELLE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EAST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5014
Mailing Address - Country:US
Mailing Address - Phone:203-866-8585
Mailing Address - Fax:203-852-1187
Practice Address - Street 1:111 EAST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5014
Practice Address - Country:US
Practice Address - Phone:203-866-8585
Practice Address - Fax:203-852-1187
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT073711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice