Provider Demographics
NPI:1992093264
Name:HOWELL A GOLDBERG DDS PA
Entity type:Organization
Organization Name:HOWELL A GOLDBERG DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWELL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-472-3303
Mailing Address - Street 1:815 S UNIVERSITY DR
Mailing Address - Street 2:STE 102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3312
Mailing Address - Country:US
Mailing Address - Phone:954-472-3303
Mailing Address - Fax:954-472-1055
Practice Address - Street 1:815 S UNIVERSITY DR
Practice Address - Street 2:STE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3312
Practice Address - Country:US
Practice Address - Phone:954-472-3303
Practice Address - Fax:954-472-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9212122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6564530001Medicare NSC