Provider Demographics
NPI:1790008415
Name:GOLDBERG, MARK ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 SW 27TH AVE
Mailing Address - Street 2:APT. 1701
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-5307
Mailing Address - Country:US
Mailing Address - Phone:954-328-3866
Mailing Address - Fax:
Practice Address - Street 1:1603 S HIAWASSEE RD
Practice Address - Street 2:SUITE 135
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6438
Practice Address - Country:US
Practice Address - Phone:407-293-8324
Practice Address - Fax:407-298-7810
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL163441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics