Provider Demographics
NPI:1922231026
Name:GOLDBERG, HARLAN GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARLAN
Middle Name:GENE
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 1:1801 SE 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5532
Mailing Address - Country:US
Mailing Address - Phone:352-622-2664
Mailing Address - Fax:352-622-2899
Practice Address - Street 1:1601 NE 25TH AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-8800
Practice Address - Country:US
Practice Address - Phone:352-622-2664
Practice Address - Fax:352-622-2899
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTC 1611223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health