Provider Demographics
NPI:1679633465
Name:GOLDBERG, DANIEL B (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
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 1:1600 BRICE RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2795
Mailing Address - Country:US
Mailing Address - Phone:614-866-5966
Mailing Address - Fax:614-866-6029
Practice Address - Street 1:1600 BRICE RD.
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2795
Practice Address - Country:US
Practice Address - Phone:614-866-5966
Practice Address - Fax:614-866-6029
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300142931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice