Provider Demographics
NPI:1265745368
Name:GOLDENBERG, ANDREW JASON (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JASON
Last Name:GOLDENBERG
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 1:61 LONG CT STE 110
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6083
Mailing Address - Country:US
Mailing Address - Phone:805-495-9810
Mailing Address - Fax:805-446-4133
Practice Address - Street 1:61 LONG CT STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6083
Practice Address - Country:US
Practice Address - Phone:805-495-9810
Practice Address - Fax:805-446-4133
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice