Provider Demographics
NPI:1912272212
Name:GOLDENBERG, BARRY S (DMD, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 213-E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-997-7972
Mailing Address - Fax:314-997-7978
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 213-E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-997-7972
Practice Address - Fax:314-997-7978
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0138111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics