Robert Ian Goldenberg, DDS
Individual provider Active NPI Dentist · Julian, CA
NPI 1205046935 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205046935
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 035889 (CA)
- Practice address
- 2602 Washington Street
Julian, CA 92036-0696 - Phone
- (760) 765-1675
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035889 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 035889 | CA | Yes |
Addresses
Primary practice location
2602 Washington Street
Julian, CA 92036-0696
Mailing address
2602 Washington Street
PO Box 696
Julian, CA 92036-0696
Phone (760) 765-1675
Other providers in Julian, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.