Provider Demographics
NPI:1629286513
Name:GOLDBERG, ERIC M (DDS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
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 1:2414 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1152
Mailing Address - Country:US
Mailing Address - Phone:810-744-3388
Mailing Address - Fax:810-744-4080
Practice Address - Street 1:2414 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1152
Practice Address - Country:US
Practice Address - Phone:810-744-3388
Practice Address - Fax:810-744-4080
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010156671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics