Provider Demographics
NPI:1881847291
Name:GOLDBERG, STEVEN M (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
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 1:400 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:516-579-7577
Mailing Address - Fax:631-422-6366
Practice Address - Street 1:3601 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 110
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756
Practice Address - Country:US
Practice Address - Phone:516-579-7577
Practice Address - Fax:516-731-0240
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0318241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist