Provider Demographics
NPI:1588907331
Name:GOLDBERG, NANCY JOY (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JOY
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 COCKEYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-5118
Mailing Address - Country:US
Mailing Address - Phone:410-517-2056
Mailing Address - Fax:
Practice Address - Street 1:722 COCKEYS MILL RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-5118
Practice Address - Country:US
Practice Address - Phone:410-517-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist