Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2901015879 | MI |
NPI | 1043326879 |
---|---|
Provider Name | Dr. Lisa Goldberg |
First Address | Rochester Hills, MI 48307-3532 |
Second Address | Rochester Hills, MI 48307-3532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |