Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 10722 | CO |
NPI | 1063723252 |
---|---|
Provider Name | Rebecca Haley Goldberg |
First Address | Highlands Ranch, CO 80129-2246 |
Second Address | Highlands Ranch, CO 80129-2246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 13/08/2012 |