Provider Demographics
NPI:1669536736
Name:GOLDENBERG, MONICA (DDS MS)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 DAWN DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628
Mailing Address - Country:US
Mailing Address - Phone:512-863-8580
Mailing Address - Fax:512-366-9694
Practice Address - Street 1:3007 DAWN DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-863-8580
Practice Address - Fax:512-366-9694
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics