Provider Demographics
NPI:1891714598
Name:SMITH, GOLBARG D (DMD)
Entity Type:Individual
Prefix:DR
First Name:GOLBARG
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6302
Mailing Address - Country:US
Mailing Address - Phone:727-327-4040
Mailing Address - Fax:727-323-3589
Practice Address - Street 1:4000 5TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6302
Practice Address - Country:US
Practice Address - Phone:727-327-4040
Practice Address - Fax:727-323-3589
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist