Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12572 | TX |
NPI | 1043216245 |
---|---|
Provider Name | Dr. Marshal D Goldberg |
First Address | Dallas, TX 75225-4423 |
Second Address | Dallas, TX 75225-4423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |