Provider Demographics
NPI:1750447165
Name:BARRY S. GOLDENBERG, D.M.D., M.S., P.C.
Entity Type:Organization
Organization Name:BARRY S. GOLDENBERG, D.M.D., M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GOLDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:314-997-7972
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 213-E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-997-7972
Mailing Address - Fax:314-997-7978
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 213-E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-997-7972
Practice Address - Fax:314-997-7978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0138111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty