Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10213 | NC |
N | 1223X0400X | Orthodontists | MADN1855246 | MA |
NPI | 1003048455 |
---|---|
Provider Name | Dr. Jeffrey Alan Goldberg |
First Address | High Point, NC 27262-4936 |
Second Address | High Point, NC 27262-4936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2009 |
Last Update Date | 27/03/2019 |