Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 01642 | MA |
NPI | 1083699862 |
---|---|
Provider Name | Dr. Norman Leon Goldberg |
First Address | Sudbury, MA 01776-1322 |
Second Address | Concord, MA 01742-2189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/07/2007 |